No abstract available.

No abstract available.
Anesthesia

Pulmonary embolism (PE), which can originate as a consequence of deep vein thrombosis (DVT), is the most frequent and potentially fatal venous thromboembolic event. Despite the fact that the incidence of venous thromboembolism (VTE) in Asians is lower than that in the Western populations, a recent epidemiologic study demonstrates an increasing incidence of VTE in the Korean population. Anticoagulants, including low molecular weight heparin (LMWH) and vitamin K antagonist (VKAs), have been the main treatments for PE, however, recently new oral anticoagulants (NOACs) were introduced. We will review how well patients with PE can be managed with the existing anticoagulants and NOACs along with the time span of treatment, which still pose some challenges for clinicians.
Anticoagulants ; Asian Continental Ancestry Group ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Pulmonary Embolism ; Venous Thromboembolism ; Venous Thrombosis ; Vitamin K

No abstract available.
Anesthesia* ; Liver Transplantation* ; Liver*

The autonomic nervous system (ANS) contributes importantly to the short-term regulation of blood pressure and cardiovascular variability. Evidence from numerous studies indicates a strong association among compromised ANS, sudden cardiac death, blood pressure instability and adverse postoperative cardiac events. Heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) have been studied for years as tools for assessing ANS. In this review, physiological origin and measurement principle of cardiovascular fluctuations are described and changes in indices of HRV, BPV and BRS observed in various situations of anesthesia are discussed. Anesthesiologists need to consider estimation of ANS function to predict hypertension/hypotension after anesthesia induction and to improve short-term outcome and long-term cardiac morbidity and mortality.
Anesthesia ; Anesthesiology ; Autonomic Nervous System ; Baroreflex ; Blood Pressure ; Death, Sudden, Cardiac ; Heart ; Heart Rate

No abstract available.
Anesthesia ; Natriuretic Peptide, Brain

BACKGROUND: In critically ill patients, cardiac output (CO) is used as a parameter for assessing hemodynamic status and efficacy of treatment. Continuous CO (CCO) could facilitate this assessment during general anesthesia. A new method of arterial pulse wave analysis has been introduced, which estimates beat to beat CO from arterial pressure via Modelflow. It remains uncertain how well this method performs in high output states. We analyzed the relationship between CCO and Modelflow computed from radial and femoral pressures (MFCO(RA), MFCO(FA)) during liver transplantation (LT). METHODS: Measurements were performed in 100 liver transplant patients. Groups A had 36 patients, and group C had 64 patients with both groups composed of Child-Turcotte A, B and C patients Eighty patients had CCO < 10 L/min (group D), and 20 patients had CCO > 10 L/min (group E) during anhepatic phase. RESULTS: CCO ranged from 5.0 to 15.4 L/min (MFCO(RA) 3.2 to 10.7 L/min, MFCO(FA) 4.3 to 11.8 L/min). Bland-Altman analyses showed the limit of agreement of MFCO(RA) (-1.5 to 5.2, bias = 1.9 L/min) and of MFCO(FA) (-2.6 to 4.4, bias = 0.9 L/min). CO measured by the two methods was significantly different in groups, except for MFCO(FA) in group C. In group D, bias was 1.5 L/min (SD 1.3 L/min) for MFCO(RA) and 0.9 L/min for MFCO(FA) (SD 1.4 L/min). In group E, biases of 3.5 L/min and 2.4 L/min were obtained for MFCO(RA) and MFCO(FA), respectively. CONCLUSIONS: These results suggest that the group-average value of MFCO is not an accurate parameter for estimating CO during LT, with the exception of MFCO(FA) in groups C and D.
Anesthesia, General ; Arterial Pressure ; Bias (Epidemiology) ; Cardiac Output ; Critical Illness ; Hemodynamics ; Humans ; Liver ; Liver Transplantation ; Pulse Wave Analysis ; Thermodilution ; Transplants

BACKGROUND: A prolonged QT interval can lead to malignant ventricular arrhythmias and sudden cardiac death, and has frequently been found in end-stage liver disease (ESLD). However, myocardial repolarization lability has not yet been fully investigated. We evaluated the QT variability index (QTVI), a marker of temporal inhomogeneity in ventricular repolarization and an abnormality associated with re-entrant malignant ventricular arrhythmias. We determined whether QTVI is affected by the head-up tilt test in ESLD. METHODS: We assessed 36 ESLD patients and 12 control subjects without overt heart disease before and after the 70-degree head-up tilt test. The electrocardiography signal (lead II) was recorded on a computer with an analog-to-digital converter. The RR interval (RRI) and QT interval were measured after recording 5 min of the digitized electrocardiography. Then, the QT intervals were corrected with Bazett's formula (QTc). QTVI was calculated through the following formula: QTVI = log10 [(QTv/QTm2)/(RRIv/RRIm2)], QTv/RRIv: variance of QTI/RRI, QTm/RRIm: mean of QT interval/RRI. RESULTS: Cirrhotic patients exhibited an elevated QTVI. In particular, Child class C patients had a significantly increased QTVI compared to Child class A patients and the control subjects in the supine position. However, the head-up tilt test did not cause a significant difference in QTVI in relation to the severity of ESLD. CONCLUSIONS: Myocardial repolarization lability was significantly altered in end-stage liver disease. Our data suggest that the severity of ESLD is associated with the degree of the alteration in the QT variability index.
Arrhythmias, Cardiac ; Child ; Death, Sudden, Cardiac ; Electrocardiography ; Heart Diseases ; Humans ; Liver Diseases* ; Liver* ; Supine Position

BACKGROUND: The sequence method of determining baroreflex sensitivity (BRSSEQ) has been reported to correlate poorly with the phenylephrine method of determining BRS in individuals with attenuated BRS. Inhalation anesthetics are also known to decrease BRS. We therefore assessed the effect of varying the systolic blood pressure (SBP) and R-R interval (RRI) thresholds on BRSSEQ values and compared these results with the BRS obtained by the modified Oxford technique (BRSMODOX). METHODS: The average number of valid sequences and BRSSEQ values were derived by varying the SBP threshold from 0.5 to 2.5 mmHg and the RRI threshold from 1 to 6 ms, and the relation of BRSSEQ values to BRSMODOX values using sequential administration of nitroprusside and phenylephrine was assessed in 40 healthy individuals during sevoflurane anesthesia. RESULTS: Increasing either the SBP thresholds or RRI thresholds resulted in a decrease in the number of valid sequences. As the SBP thresholds were decreased and the RRI thresholds were increased, BRSSEQ values increased. When the SBP threshold exceeded 1 mmHg, no significant correlations were observed between BRSSEQ and BRSMODOX values. Significant correlations between the two methods were observed for an SBP threshold of 0.5 mmHg and RRI thresholds of 1, 2, 3 and 4 ms. Biases between the two methods were 2.1, 2.1, 0.4, and 0.4 ms/mmHg for 0.5 mmHg and 1, 2, 3 and 4 ms. CONCLUSIONS: These findings suggest that adjusting the SBP threshold to 0.5 mmHg and the RRI threshold to 3 or 4 ms may improve BRSSEQ validity during sevoflurane anesthesia, when compared to BRSMODOX.
Anesthesia* ; Anesthetics, Inhalation ; Baroreflex* ; Bias (Epidemiology) ; Blood Pressure* ; Nitroprusside ; Phenylephrine

No abstract available.
Fentanyl ; Syringes