We define acute respiratory failure(ARF) as present whenever the ratio of arterial oxygen tension (PaO2) and inspired oxygen concentrarion(FiO2) is below the normal predicted range for the patient's age and/or the arterial carbon dioxide tension(PaCO2) is above 45 in the absence of respiratory compention for metabolic alkalosis. Adult respiratory distress syndrome(ARDS) which is associated with shock, trauma, infection, inhalation of toxic gas, aspiration of gastric content and drugs etc, first received wide-spread attention in 1967. ARDS is a descriptive term that is characterized by a combination of refractory hypoxemia and severly decreased lung compliance. Numerous specific incidents or illnesses may be complicated by, or associated with ARDS. Early diagnosis and improvement in physiological therapy including PEEP therapy have been successful in treating the early and mild episodes of ARDS. This report describes three cases of ARF following anesthesia and reviews the literature.
Adult ; Alkalosis ; Anesthesia* ; Anoxia ; Carbon Dioxide ; Early Diagnosis ; Humans ; Inhalation ; Lung Compliance ; Oxygen ; Respiratory Insufficiency* ; Shock

Preoxygenation is routine preior to induction of general anesthesia for the purpose of maintaining oxygenation during laryngoscopy and tracheal intubation. A common method of preoxygenation is 3~5 minutes of 100% O2 breathing. In some emergency states, ther may not be adequate time for a full 3~5 min of preoxygenation. REcently, Gold and some others showed that four maximally deep inspirations of 100% O2 within 30 seconds are as effective as 5 minutes of inhaltion of 100% O2 for increasing the PaO2. We compared the changes of arterial blood gas between a group which took deep breaths for 1 minute with 100% O2 and a group breathing spontaneously for 5 minutes with 100% O2.
Anesthesia, General ; Emergencies ; Humans ; Intubation ; Laryngoscopy ; Oxygen ; Respiration

Recent research has led to the discovery and characterization of a hormone secreted by the atria that has powerful vasopressive and natriuretic properties. Various atrial natriuretic peptides(ANP) were isolated and synthetized, and the effects were investigated by many workers. This study was attempted to access the effects of high dose morphine anesthesia on the plasma ANP level, renin activity and renal function in patients with cardiac surgery. Anesthesia was induced with morphine and maintained with 50% nitrous oxide in oxygen. Supple-mentary dose of morphine was given during the anesthesia according to responses of patients. The results were as follows: 1) The blood pressure and heart rate were not chaged significantly during anesthesia compared with the control values. 2) There was no statistically signigicant difference of plasma ANP level compared with the control values. 3) The plasma concentration of renin was markedly elevated after 30 minutes of induction time and sustained it during the anesthesia. Recovery to normal range of plasma renin concentration was observed after 2 days of surgery. This change is much the same as the other anesthetic methods. 4) Tendency of decreasing urine volume was shown just after the induction period but restored to control level immediately. 5) The renal excretory rate of sodium chloride and fractional excretion of sodium was significantly decreased during anesthesia and restored to control level after surgery. These results show that morphine anesthesia dose not produce significant alteration of both ANP and renin-angiotensin system.
Anesthesia* ; Atrial Natriuretic Factor* ; Blood Pressure ; Heart Rate ; Humans ; Morphine* ; Nitrous Oxide ; Oxygen ; Plasma* ; Reference Values ; Renin* ; Renin-Angiotensin System ; Sodium ; Sodium Chloride ; Thoracic Surgery*

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal acute hypersensitivity reactions that involve the skin and mucous membranes. Because they are relatively rare diseases, it is difficult to obtain well-organized epidemiological data. The clinicodemographic characteristics, culprit drugs, and factors related to disease prognosis may vary. Objective: To identify the characteristics of SJS/TEN by investigating patient clinicopathological characteristics, laboratory findings, suspected drugs, and mortality through a retrospective study using medical record data. Methods: The clinical records of patients diagnosed with SJS/TEN between February 2009 and February 2019 at three medical institutions of Soonchunhyang University were retrospectively reviewed. Data pertaining to sex, age, history, suspected drugs, latent period, laboratory findings, and mortality were collected, and their correlations were analyzed. Results: We identified SJS/TEN in 88 patients. Among the probable causative agents, antibiotics were the most common (29 cases, 33.0%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) in 20 cases (22.7%). The period between drug administration and symptom onset varied with the causative agent. Patients who died had high SCORTEN scores. In addition, hypertension, diabetes, renal failure, and cardiac disease had a statistically significant association with high SCORTEN. Conclusion Antibiotics, NSAIDs, antiepileptics and allopurinol were the most commonly implicated drugs in our retrospective study. There was a significant correlation between comorbidities. Because SJS/TEN is a life-threatening condition, early recognition of the suspected drug are important. The results of this study may provide insights that aid in the early diagnosis and prediction of disease outcomes of SJS/TEN in the Korean population.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal acute hypersensitivity reactions that involve the skin and mucous membranes. Because they are relatively rare diseases, it is difficult to obtain well-organized epidemiological data. The clinicodemographic characteristics, culprit drugs, and factors related to disease prognosis may vary. Objective: To identify the characteristics of SJS/TEN by investigating patient clinicopathological characteristics, laboratory findings, suspected drugs, and mortality through a retrospective study using medical record data. Methods: The clinical records of patients diagnosed with SJS/TEN between February 2009 and February 2019 at three medical institutions of Soonchunhyang University were retrospectively reviewed. Data pertaining to sex, age, history, suspected drugs, latent period, laboratory findings, and mortality were collected, and their correlations were analyzed. Results: We identified SJS/TEN in 88 patients. Among the probable causative agents, antibiotics were the most common (29 cases, 33.0%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) in 20 cases (22.7%). The period between drug administration and symptom onset varied with the causative agent. Patients who died had high SCORTEN scores. In addition, hypertension, diabetes, renal failure, and cardiac disease had a statistically significant association with high SCORTEN. Conclusion Antibiotics, NSAIDs, antiepileptics and allopurinol were the most commonly implicated drugs in our retrospective study. There was a significant correlation between comorbidities. Because SJS/TEN is a life-threatening condition, early recognition of the suspected drug are important. The results of this study may provide insights that aid in the early diagnosis and prediction of disease outcomes of SJS/TEN in the Korean population.