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*

No abstract available.
Anesthesia ; Natriuretic Peptide, Brain

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

BACKGROUND: The arterial baroreflex is a key mechanism involved in blood pressure (BP) homeostasis and serves as a pressure buffer system against increase and decrease in BP. In contrast to awake patients, little has been known about correlations among METHODS assessing spontaneous baroreflex sensitivity (SBRS) during general anesthesia. The aim of present study was to compare SBRS obtained from sequence method and transfer function analysis (TFA), and examined their relationship to vagal cardiac function in patients during sevoflurane general anesthesia. METHODS: 20 patients were anesthetized with 1 MAC sevoflurane with 50% N2O and mechanically ventilated at 0.25 Hz. 5 min beat-to-beat BP and electrocardiogram were recorded to assess sequence BRS and TFA BRS from spontaneous RR interval and systolic BP fluctuation. We derived 4 proposed indices (Sequence BRS, low frequency (LF) BRS, high frequency (HF) BRS, and average BRS). RESULTS: The indices were correlated with each other significantly and the Bland-Altman method demonstrated that sequence BRS was in close agreement with each other except LF BRS. The indices were also correlated highly with HF heart rate variability representing vagal cardiac function. CONCLUSIONS: SBRS was related to vagal cardic function. Because of the correlations and agreements between these two METHODS, it may employ them except for LF BRS during sevoflurane general anesthesia.
Anesthesia* ; Anesthesia, General ; Baroreflex* ; Blood Pressure ; Electrocardiography ; Heart Rate ; Homeostasis ; Humans

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