Anesthetic care is usually provided for patients undergoing surgical procedures to make them unconscious and painless during surgery. Nowadays there are increasing therapeutic or diagnostic procedures performed outside operating room. Sedation is more frequently provided as healthcare during procedures for patient's comfort and safety by non-anesthesiologist or anesthesiologist. Early in 1999, ASA (the American Society of Anesthesiologists defined sedation and analgesia and established 4 states: minimal sedation, moderate sedation, deep sedation, and general anesthesia. Monitored anesthetic care implies the potential for a deep sedation and is always administered by an anesthesiologist. It is not always possible to predict how an individual patient will respond by nature of being a continuum of sedation. Hence, practitioners intending to induce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. The standards for preoperative evaluation, intraoperative monitoring, anesthetic care, etc. are not different from those for general anesthesia.
Analgesia ; Anesthesia* ; Anesthesia, General ; Conscious Sedation ; Deep Sedation ; Delivery of Health Care ; Humans ; Methods ; Monitoring, Intraoperative ; Operating Rooms

BACKGROUND: A thoracic epidural combined with general anesthesia may reduce the oxygen demand of the heart by cardiac sympathetic blockade, but it may also reduce the systemic and cardiac oxygen delivery due to hypoperfusion which is critical to patients with significant coronary lesions. This study was done to investigate the effects of thoracic epidural anesthesia on the systemic and cardiac oxygen supply/demand balance during coronary occlusion in dogs. METHODS: In 10 dogs, the left circumflex coronary artery was occluded, and then thoracic epidural anesthesia was given at the T5-6 or T6-7 level with 5 ml of 0.5% bupivacaine to block T1-T12 through the surgically introduced epidural catheter. Hemodynamic parameters and arterial, mixed venous and coronary sinus blood samples were obtained at baseline and 30 minutes after coronary occlusion. The same parameters were also measured at 30, 60, 90, 120 and 150 minutes after the epidural blockade. An epicardial 2D-echocardiogram was done by a cardiologist at baseline, 30 minutes after occlusion and 1 hour after the epidural blockade. RESULTS: Systemic oxygen delivery (O2 flux) was decreased after epidural anesthesia (p < 0.05), but oxygen consumption (VO2) was maintained throughout the experimental periods. Although the systemic oxygen extraction ratio (O2ER) was not changed, cardiac O2ER was increased at 90, 120 and 150 minutes after epidural anesthesia (p < 0.05). The end-diastolic noncontractile area of the left ventricle was increased, pulmonary capillary wedge pressure was increased 90 minutes after epidural anesthesia and cardiac output was decreased 120 minutes after epidural anesthesia (p < 0.05). CONCLSIONS: In the experimental canine model of coronary occlusion, thoracic epidural anesthesia induces diminished systemic oxygen delivery without deteriorating oxygen supply/demand balance. However, as PsO2 and SsO2 diminished and the noncontractile left ventricular area increased after epidural anesthesia in the setting of acute coronary occlusion, perioperative use of thoracic epidural anesthesia in patients of coronary disease should be done carefully in order not to aggravate myocardial ischemia.
Anesthesia, Epidural* ; Anesthesia, General ; Animals ; Bupivacaine ; Cardiac Output ; Catheters ; Coronary Disease ; Coronary Occlusion* ; Coronary Sinus ; Coronary Vessels ; Dogs* ; Heart ; Heart Ventricles ; Hemodynamics ; Humans ; Myocardial Ischemia ; Oxygen Consumption ; Oxygen* ; Pulmonary Wedge Pressure

BACKGROUND: A retrospective study was performed to evaluate postoperative mortality within 30 days following surgery. METHODS: The records of 31,806 patients who received operation under general anesthesia were reviewed. RESULTS: 1) Postoperative deaths were 184 cases, the ratio of which was comprising 0.57% of all surgical operative cases. 2) The highest ratio of the mortality in age group was 51~60 years group which was 24.5%, and in physical status it was ASA class III which was 36.4%. The highest ratio to the mortality rate in postoperative days was 8~30 days which was 45.1%. 3) The most common causes of death was low cardiac output due to heart failure on operating theater, and hypovolemic shock within postoperative 2 days, and intracranial problem within postoperative 7 days, and pulmonary complication within postoperative 30 days. CONCLUSION: We conclude that fatality rate could be decreased by intensive and multidisciplinary care for postoperaive complications as respiratory and renal failure.
Anesthesia, General ; Cardiac Output, Low ; Cause of Death ; Heart Failure ; Humans ; Mortality ; Renal Insufficiency ; Retrospective Studies ; Shock

Background: The highly lipid soluble opioid, fentanyl, has a rapid onset and short duration of action. The present study was designed to examine the analgesic efficacy and side effects of the combination of fentanyl with morphine in patients using intravenous PCA. Methods: Patients were randomly assigned to receive one of three PCA regimens: M4 group (40 mg morphine+90 mg ketorolac+1.5 mg dorperidol), M2F2 group (20 mg morphine+200 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol), or M2F4 group (20 mg morphine+400 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol). All patients were given initial loading dose of 0.1 mg/kg morphine plus 1 mg droperidol at the end of surgery. Pain score, side effects, and overall satisfaction were assessed at 30 min, 1 hr, 8 hr, 24 hr, and 48 hr postoperatively. Results: The pain score was significantly higher in the M2F2 group than in the M4 group and M2F4 group during 1 hr and 8 hr postoperatively. The total opioid consumption was significantly greater in the M2F4 group than in the M4 group. Patient satisfaction was better in the M2F4 than other two groups. There were no differences in the overall incidence of side effects among three groups. Conclusions: The present results suggest that the combination of fentanyl with morphine for intravenous patient-controlled analgesia is a useful method, and the double dose of fentanyl in comparison with the equipotent morphine dose is recommended in the early postoperative period.
Analgesia, Patient-Controlled* ; Droperidol ; Fentanyl* ; Humans ; Incidence ; Morphine* ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Postoperative Period

Background: We hypothesized that intravenous lidocaine mixed with propofol may have an influence on anesthesia induction and hemodynamic responses to propofol induction and endotracheal intubation as well as propofol-induced pain on injection. Methods: Seventy-five patients were allocated to group L1 (2% lidocaine 1.5 mg/kg, n=25), group L2 (2% lidocaine 2 mg/kg, n=25) or group C (normal saline 0.05 mL/kg, n=25) according to the lidocaine dosage mixed with propofol 2 mg/kg. The pain on injection was scored as none, mild, moderate, and severe. The site of pain and recall of pain were also recorded. Loss of verbal response was observed during induction. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded before anesthetic induction (baseline value), immediately before and after endotracheal intubation, and every min until 5 min thereafter. Results: Ninety-two percent of patients reported pain upon injection in group C, whereas 8% of the patients in group L1 and no patient in group L2. Loss of verbal response before injection of total dose of propofol was observed in 44% in group L2, 36% in group L1 and 28% in group C. Lowered MAP caused by propofol increased significantly after endotracheal intubation in all three groups (p<0.05). HR increased immediately and 1 min after endotracheal intubation in all three groups (p<0.05). Conclusions: Our results indicate that intravenous lidocaine 1.5 mg/kg or 2 mg/kg mixed with propofol 2 mg/kg significantly reduces the incidence and the degree of pain, but does not affect anesthesia induction and hemodynamic responses to propofol and tracheal intubation.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Lidocaine* ; Propofol*

PURPOSE: To determine (1) the relationship between the cortical defects seen on 99 mTc-DMSA renal scans and age, and (2) the presence and degree of vesicoureteral reflux, and then to depict the risk factors for cortical defects in children with acute urinary tract infection (UTI). Furthermore, to assess the diagnostic value of VCUG in predicting a defect on 99 mTc-DMSA renal scans. MATERIALS AND METHODS: We studied 134 kidneys in 67 children aged 15 days-10 years (M:F=39:28) in whom symptomatic UTI was present. In all these children, both DMSA renal scans and voiding cystourethrography (VCUG) were performed. Scanning took place within 7 days of diagnosis and VCUG was performed after one month of diagnosis. Scintigraphic findings were graded according to the extent and number of cortical defects. We evaluated the relationships between the cortical defects seen on DMSA scans and age, and the grade of vesicoureteral reflux. The diagnostic value of VCUG in predicting cortical defects was analysed. Results: The prevalence of cortical defects was greater in patients older than two years (38/54, 70%) than in those aged less than two (38/80, 48%). The frequency of cortical defects was related to vesicoureteral reflux (p<0.05) and grade of reflux (p<0.05). As this latter increased, the extent of cortical defects also increased (p<0.05), and DMSA scans revealed the presence of these in 76 of the 134 kidneys (57%) with acute UTI. In 30 of these 76 (39.5%), VCUG demonstrated the presence of vesicoureteral reflex. On the other hand, vesi-coureteral reflex was found in 36 of the 134 kidneys (27%), and in 30 of these 36 (83%), cortical defects were noted. The sensitivity of VCUG in predicting cortical defect was 39.5%, while specificity was 89.7%. The positive predictive value for defects was 83.3%, and the negative predictive value was 53.1%. The relative risk of cortical defect in the presence of vesicoureteral reflux was 1.78. CONCLUSION: Renal cortical defects are significantly related to age and grade of vesicoureteral reflux. Risk factors for developing cortical defects were older age (> or =2yrs) at the time of acute UTI, and high grade of vesicoureteral reflux. The specificity of VCUG in predicting cortical defects is relatively high but the sensitivitiy is low, and a significant proportion of cortical defects therefore occurred in the absence of vesicoureteral reflux.
Child* ; Diagnosis ; Hand ; Humans ; Kidney ; Prevalence ; Radionuclide Imaging* ; Reflex ; Risk Factors* ; Sensitivity and Specificity ; Succimer* ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

The need for a short-acting non-depolarizing neuromuscular blocking agent to replace succinylcholine chloride(succinylcholine) is recognized widely and attempts to find such a drug have been numerous. Atracurium besylate(atracurium) is one of the new series of neuromuscular blocking agents with little cardiovascular effect and is not dependent on hepatic and renal function for terminating its action because of its self-destroying mechanism. Because succinylchline may occasionally be contraindieated for intubation in parturients we studied the use of atracurium in 23 patients having cesarean section. All patients received 0. 5 mg/kg atracurium for intubation and neuromuscular relaxation. Hemodynamic changes, the time from the injection of atracurium to maximal twitch suppression, the time between atracurium administration and the return to 10% of control twitch height were recorded and observed the degree of vocal cord relaxation and conditions of intubation and evaluated the Apgar scores. 1) Mean arterial pressure and heart rate increased significantly after intubation compared with that of control and just before intubation but there were no significant changes in 5 minutes after intubation. 2) The 90% twitch suppression following atracurium administration was 75.6+/-20.9 seconds. 3) The return of 10% of control twitch height was 2449.3+/-1114.0 seconds. 4) Intubation conditions were excellent for 19 patients. 5) The Apgar scores of 20 neonates were high. These data suggest that the use of atracurium may be a useful alternative for induction for Cesarean section when succinylcholine is contraindicated.
Arterial Pressure ; Atracurium* ; Cesarean Section* ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pregnancy ; Relaxation ; Succinylcholine ; Vocal Cords

We noted hemoglobinuris during and after extracorporeal circulation for one case of mitral valve replacement. Laboratory results revealed autoimmune hemolytic anemia(AIHA) including a positive direct Coombs test. A patient with AIHA is serologically incompatible with his own red cells and with the red cells of most blood donors. Red cell transfusion is essential for the management of life threatenting anemia especially in this case. So it is essential, therefore, to have efficient clinician blood bank communication in order to arrive at a rational transfusion therapy for these patients.
Anemia ; Anemia, Hemolytic* ; Blood Banks ; Blood Donors ; Coombs Test ; Extracorporeal Circulation* ; Humans ; Mitral Valve

There are many predisposing factors for acute pulmonary edema, namely, left ventricular failure due to cardiac disease or fluid overloading, hypoalbuminemia, pulmonary capillary endothelial damage from bacterial toxins or irritant gases, rare central nervous system injuries pulmonary hyersensitivity reactions, etc. Acute pulmonary edema following operations is a rare complication especially in a patient whose preoperative cardiopulmonary status was within normal limits. We present a case of unilateral pulmonary edema immediately following operation in a 46 year old male patient who had a modified pull-through operation due to tongue cancer and who had no evidence of preoperative cardiopulmonary disorders. The edema was relieved after 9 hours with intensive care of pulmonary edema such as IPPB with Omorphine, diuretics, corticosteroid, asemi-sitting position and frequent tracheal suction.
Bacterial Toxins ; Capillaries ; Causality ; Central Nervous System ; Diuretics ; Edema ; Heart Diseases ; Humans ; Hypoalbuminemia ; Critical Care ; Intermittent Positive-Pressure Breathing ; Male ; Middle Aged ; Noble Gases ; Pulmonary Edema* ; Suction ; Tongue Neoplasms

The changes in heart rate, systolic, mean and diastolic arterial blood pressure, and the plasma concentration of epinephrine and norepinephrine were measured before and thmughout the induction periods of anesthesia in 60 elective surgical patients in a randomized, double-blind manner to evaluate the effects of continuous intravenous infusion of esmolol for 1 minute at 500 ug/kg/min as a loading dose and for 4 minutes at 100 ug/kg/min as a maintenance dose. The control group (n=30) was given the continuous infusion of normal saline at the same volume-rate. During the study, anesthesia was maintained with N2O-O2-enflurane-vecuronium and controlled ventilation. In the esmolol group, statisticaUy, the heart rate at 1 minute after the intubation was less increased and systolic and diastolic pressure after 11 minutes were more decreased than the control group. And plasma norepinephrine concentration was elevated more than the control group at 3 minutes after the intubation. We concluded that the used infusion rate of esmolol blunted the hemodynamic changes following the laryngoscopy and endotracheal intubation but it is still needed to find the dosage for complete blocking the adrenergic response.
Anesthesia ; Arterial Pressure ; Blood Pressure ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Infusions, Intravenous* ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Norepinephrine ; Plasma ; Ventilation