No abstract available.
Cardiopulmonary Bypass ; Weaning

No abstract available.
One-Lung Ventilation*

No abstract available.
Informed Consent* ; Malpractice*

Iatrogenic aortic dissection (IAD) is a life-threatening complication that can occur during open heart surgery, therefore IAD requires early diagnosis and prompt management. We describe here a case of IAD that occurred during mitral valve replacement. The transesophageal echocardiography (TEE) evaluation revealed features indicative of acute aortic dissection and the tear was successfully repaired by interposition of a graft.
Early Diagnosis ; Echocardiography, Transesophageal ; Mitral Valve* ; Thoracic Surgery ; Transplants

Video-assisted thoracoscopic surgery (VATS) has advantages compared with open thoracotomy. One lung ventilation, is indispensible to VATS, commonly is accomplished with a double-lumen endotracheal tube. For infants and small children, there is no double-lumen endotracheal tube suitable, various modified techniques are used to achieve one lung ventilation. Recently introduced a small sized wire-guided endobronchial blocker gives us another choice of one lung ventilation for VATS in small children. Using a wire-guided endobronchial blocker and multiport adapter for young children under flexible bronchoscope, we provided one lung ventilation (OLV) during VATS successfully without complications.
Bronchoscopes ; Child ; Humans ; Infant ; One-Lung Ventilation ; Thoracic Surgery, Video-Assisted ; Thoracotomy

Left ventricular aneurysm (LVA) and false aneurysm are complications of acute myocardial infarction, trauma, and cardiac surgery. Left ventricular false aneurysm (LVFA) is a particularly catastrophic complication owing to its high propensity for rupture. Surgical resection should be considered for LVFA occurring within three months after myocardial infarction or development of congestive heart failure. In this report, we describe a case of acute heart failure with LVA and LVFA occurring in stage as a complication of myocardial infarction in a 55-year-old man. The patient was also at risk of brain ischemia due to abnormal vessel status and a previous cerebrovascular accident with left-sided weakness. Successful perioperative anesthetic management was achieved by focusing on maintaining marginal upper normal blood pressure to ensure cerebral perfusion and to reduce the risk of false aneurysm rupture.
Aneurysm* ; Aneurysm, False* ; Blood Pressure ; Brain Ischemia ; Heart Failure ; Humans ; Middle Aged ; Myocardial Infarction ; Perfusion ; Rupture ; Stroke ; Thoracic Surgery

BACKGROUND: The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA) with the classic laryngeal mask airway when used by novice personnel. METHODS: There were 114 patients enrolled into this study who underwent general anesthesia were randomly allocated into one of 2 groups; LMA group (n = 57) or SLIPA group (n = 57). After insertion, insertion success rate, insertion time, and hemodynamic responses to insertion were accessed. After surgery, postoperative airway morbidity (sore throat, dysphonia, dysphagia) were evaluated. RESULTS: The SLIPA was successfully inserted in 96% of patients (55/57) and the LMA in 93% (53/57) (P = 0.408). First attempt success rates were 88% (44/57) and 77% (50/57) in the SLIPA and the LMA (P = 0.142). The successful insertion time in SLIPA group (33.4 +/- 11.0 sec) was significantly shorter than that of LMA group (38.8 +/- 16.6 sec) (P = 0.048) and the insertion time at the first attempt was also shorter in SLIPA group (31.0 +/- 6.3 sec) than LMA group (34.7 +/- 8.6 sec) (P = 0.013). There was no statistically significant difference between the two groups in hemodynamic responses and postoperative airway morbidity. CONCLUSIONS: The SLIPA was similar to the LMA in insertion success rate, hemodynamic response, and postoperative airway morbidity by novice personnel. The insertion time at the first attempt and successful insertion time of the SLIPA were significantly shorter than those of the LMA. Therefore, the SLIPA could be a useful alternative to the LMA as primary SGA for novice personnel.
Anesthesia, General ; Dysphonia ; Hemodynamics ; Humans ; Laryngeal Masks ; Pharynx

BACKGROUND: Lipid-emulsion propofol (LP) has cardioprotective effects against ischemia-reperfusion injury, but it has lipid-related side effects. Microemulsion propofol (MP) is a lipid-free propofol emulsified with 10% purified poloxamer 188 (PP188). PP188 is a nonionic surfactant and has cardioprotective effects. However, some reports have suggested that reduced cardioprotective effects were observed when the cardioprotective agents were used in combination even though each cardioprotective agent has cardioprotective effects. The aims of this study were to examine and compare the cardioprotective effects of MP and LP. METHODS: 50 isolated rat hearts were perfused with modified Kreb's solution. They were divided into 4 groups and underwent 30 minutes of ischemia and 60 minutes of reperfusion. Control group: ischemia-reperfusion was performed without treatment. LP, MP and PP groups: LP, MP and PP188 were infused during the pre-ischemic and reperfusion period, respectively. Hemodynamic parameters and coronary effluent flow rate (CEFR) were measured. Infarct size was determined using triphenyl-tetrazolium staining. RESULTS: In the MP group, systolic pressure was maintained near baseline, the systolic pressure was higher than that in the other groups and HR was lower than that in the other groups during reperfusion. Diastolic pressure was transiently increased in the PP group after treatment and at 5 minutes after reperfusion compared with that in the control group and in the the LP group. There were no differences in dP/dtmax and CEFR between groups. Infarct size in the LP, MP and PP groups was smaller than that in the control group, but there were no significant differences between these three groups. CONCLUSIONS: MP has cardioprotective effects similar to those of LP. MP can be used for cardiac anesthesia in cases with ischemia-reperfusion injury to avoid the lipid-related side effects of LP.
Anesthesia ; Animals ; Blood Pressure ; Cardiotonic Agents ; Heart ; Hemodynamics ; Ischemia ; Poloxamer ; Propofol ; Rats ; Reperfusion ; Reperfusion Injury

Massive air leakage through a lacerated lung produces inadequate ventilation and hypoxemia. Tube exchange from a single to double lumen endotracheal tube (DLT), and lung separation to maintain oxygenation, are challenging for seriously injured patients. In this case report, we aim to describe how a bronchial blocker (BB) makes it easier to perform a lung separation in this situation; it also increases the overall safety of the procedure. A 35-year-old female (163 cm, 47 kg) suffered from blunt chest trauma due to a traffic accident; the accident caused right-sided lung laceration with massive air leakage. Paradoxically, positive ventilation worsened SaO2 and leakage increased through a chest tube. We introduced BB while the patient was still awake: Left-side one-lung ventilation (OLV) was established and anesthesia was induced. After PaO2 was maximized with OLV, we changed the endotracheal tube to DLT without a hypoxic event. By BB placement, we maintained PaO2 at a secure level, conducted mechanical ventilation and exchanged the tube without deterioration.
Accidents, Traffic ; Adult ; Anesthesia ; Anoxia ; Chest Tubes ; Female ; Humans ; Lacerations ; Lung ; One-Lung Ventilation ; Oxygen ; Pneumothorax* ; Respiration, Artificial ; Thorax ; Ventilation