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: A light plane of general anesthesia is chosen for fetal safety during a cesarean section. Therefore an experience of wakefulness and pain perception is not infrequent and can be distressful to patients. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study was designed to assess the adequacy of general anesthesia and to evaluate the usefulness of the BIS in monitoring the awareness during a cesarean section. METHODS: Twenty one parturients undergoing general anesthesia for an elective caesarean section were examined. Anesthesia was induced with 4 mg/kg thiopental and 1 mg/kg succinylcholine, and then followed with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min. Before administration of succinylcholine, a tourniquet was applied to the free arm and inflated to 250 mmHg. Responsiveness to verbal commands using the Tunstall isolated forearm technique was detected and the BIS was monitored throughout the study period. RESULTS: The incidence of responsiveness to verbal commands were 33% at the time of skin incision and fetal delivery respectively. BIS values of response to commands were significantly higher than that of no respose at both time points (p < 0.05). Fisher's exact test suggested that the BIS value less than 75 was related to unresponsiveness to verbal commands at time of skin incision (p < 0.05) and the BIS less than 85 at fetal delivery (p < 0.05). CONCLSIONS: These results suggest that adequate anesthesia is not provided with a mixture of 50% N2O, 50% O2 and 0.8% enflurane at a flow of 4 L/min at the time of skin incision and fetal delivery. In addition BIS could be a predictor of awareness during cesarean section under general anesthesia.
Anesthesia ; Anesthesia, General* ; Arm ; Cesarean Section* ; Consciousness Monitors* ; Enflurane ; Female ; Forearm ; Humans ; Incidence ; Pain Perception ; Pregnancy ; Skin ; Succinylcholine ; Thiopental ; Tourniquets ; Wakefulness

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

To evaluate the technique to provide rapid onset of anesthesia and postoperative pain control for cesarean section, we have used spinal anesthesia and epidural analgesia with a 26-gauge, long spinal needle through a 18-gauge Tuohy needle(Espocan) for elective cesarean section in twenty cases, 0.5% heavy bupivacaine 8-12mg was injected through spinal needle for anesthesia during operation, and then spinal needle was removed and epidural catheter was inserted into the epidural space for postoperative pain control. Ten milliliters of bupivacaine 0.125% with 0.45 mg buprenorphine was injected into epidural space through epidural catheter at the time of pain recognition in postoperative period. The results were as follows; 1) There were 5 cases(25%) of hypotension after spinal anesthesia. 2) There were 4 cases(20%) of complaint of pain during operation. 3) The time from injection of 0.5% heavy bupivacaine to onset of anethesia to T4 level is 3.8+/-1.5 minutes and the time from induction of spinal anesthesia to deliverly of infant is 10.1+/-2.9 minutes. 4) Two cases of postoperative headache were noted, but they were mild and relieved spontaneously. 5) Other analgesics were needed in two cases at postoperative periods. The technique is recommended for the anesthesia of cesarean section because it allows rapid onset of anesthesia with spinal anesthesia and gives advantages of postoperative pain control with epidural catheter.
Analgesia, Epidural* ; Analgesics ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine ; Buprenorphine ; Catheters ; Cesarean Section* ; Epidural Space ; Female ; Headache ; Humans ; Hypotension ; Infant ; Needles ; Pain, Postoperative ; Postoperative Period ; Pregnancy

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

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

BACKGROUND: Elderly patients often have postoperative psychiatric disorders compared with young patients. METHODS: This study was undertaken to compare the effects of general or regional anesthesia on postoperative psychiatric disorders in 31 elderly patients with elective orthopedic and urological surgery. Mini Mental States Examinations(MMSE) was done to find out postoperative delirium at preoperative, postoperative 6hours, 1st, 3rd, and 7th days. RESULTS: Mean changes in MMSE score after general anesthesia were significantly decreased compared with preoperative score and with in regional anesthesia at postoperative 6 hours and 1st day. Postoperative MMSE scores were decreased below 17 points in 17 patients among 22 patients in general anesthesia and 3 patients among 26 patients in regional anesthesia. Hospital admission duration were significantly prolonged in general anesthesia compare with regional anesthesia. CONCLUSIONS: The incidence of postoperative delirium is more common after general aneshtesia than after regional anesthesia. Therefore regional anesthesia is recommeded in elderly patients to decrease postoperative delirium.
Aged* ; Anesthesia, Conduction* ; Anesthesia, General* ; Delirium* ; Humans ; Incidence ; Orthopedics

In the last decade, advances in laparoscopic equipments have allowed the development of laparoscopic surgical treatment for gynecologic affeetion. The purpose of this study is to investigate the cardiovascular effects and blood gas changes during laparoscope assisted vaginal hysterectomy (LAVH) in Trendelenburg position and intraabdominal CO2 insufflation to obtain optimal surgical field. Mean arterial pressure (MAP), heart rate. SaO2, PaO2, end-tidal CO2 (ETCO2) PaCO2, pH, and peak airway pressure (PAP) were measured in twenty patients who underwent laparoscope assisted vaginal hysterectomy in Trendelenburg position and intraabdominal CO2 insufflation. Each measurement was taken immedistely after intubation (control), 15 minutes after Trendelenburg position, 30 minutes after CO2 insufflation, 15 minutes, 1 hour and 6 hrs. after CO2 deflation. ETCO2 and PAP were not measured 1 hour and 6 hrs. after deflation The results were as follows; 1) Mean arterial pressure and heart rate were decreased after Trendelenburg position, but increased after CO2 insufflation. 2) Arterial O2 saturation was decreased after CO2 insufflation, 1 hour after deflation 3) Arterial PO2 was decreased after CO2 insufflation. 4) End-tidal CO2 was increased after CO2 insufflation. 5) Arterial PCO2 was increased after CO2 insufflation compared to control value, but it was decreased at 15 minutes after CO2 deflation. Arterial PCO2 at 1 hour after CO2 deflation was higher than at 15 minutes after CO2 deflation and 6 hrs. after CO2 deflation. 6) Arterial pH was decreased after CO2 insufflation. 7) Peak airway pressure was increased after Trendelenburg position and after CO2 insufflation.
Arterial Pressure ; Female ; Head-Down Tilt ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hysterectomy, Vaginal* ; Insufflation ; Intubation ; Laparoscopes*