No abstract available.
Diazepam* ; Hemodynamics* ; Morphine* ; Pancuronium* ; Respiration, Artificial*

No abstract available.
APACHE* ; Intensive Care Units* ; Critical Care*

The occurrence of bilateral phrenic nerve injury in infants and children, usually associated with birth trauma or cardiotnoracic surgery can present difficulty in bedside recognition. The resultant bilateral diaphragmatic pareais or paralysis usually presenting as respiratory distress of difficulty in weaning from a ventilator can aignificantly prolong and complicate the hospital course. We experienced the bilateral diaphragmatic paralysis which developed after explothora-cotomy for removal of cystic hygroma in 10-month-old-age Patient. We recognized the diaphragmatic paralysis on 0ctober 16,1986 (postoperative 14 day) via fluoroscope and tracheoastomy was performed on postoperative 23 day. Electroconduction study was done twice on postoperative 19 and 40 day, in which at first neuropraxia ant later viability of phrenic nerve was revealed. The patient's spontaneous respiration was improved on postoperative 51 day and the SIMV (synchronized intermittent mandatory ventilation) and CPAP (continuous positive airway pressure) was applied, The patient was weaned from ventilator at postoperative 61 day and transferred with better condition after ICU 88 day to general ward.
Ants ; Child ; Humans ; Infant ; Lymphangioma, Cystic* ; Paralysis ; Parturition ; Patients' Rooms ; Phrenic Nerve ; Respiration ; Respiratory Paralysis* ; Ventilators, Mechanical ; Weaning

Major fracture of the intrathoracic airway following ohest trauma is a potentially lethal injury which can be repaired sueceasfullr if the diagnosis is made early. Cough, dyspnea, cyanosis, hemoptyala, mediastinal emphysema or pneumathorax, and a Deterioration of the patient's Clinical condition out of proportion to the apparant closed chest injury should alert the clinician to the possibility of this entity. This report describes the patients who damitted to the intensive care unit for ventilator support and left main bronchus rupture was recognized after 21-trauma-way with the aid of bronchogram. Aeter then pneumonetomy was done and transferred to the general ward after weaing from the ventiltor support. from the above report it can he concluded that the bronchogram with the aid of fiberoptic bronchoscope is easentially necessary for the diagnosis of the major airwar injury.
Bronchi* ; Bronchoscopes ; Cough ; Cyanosis ; Diagnosis ; Dyspnea ; Humans ; Intensive Care Units ; Mediastinal Emphysema ; Patients' Rooms ; Rib Fractures* ; Ribs* ; Rupture* ; Thoracic Injuries ; Ventilators, Mechanical

In order to determine the usefulness of Ketamine for the shocked patient, 31 cases were divided into 3 groups. Group 1: No hemorrhage or shock. Well maintained vital signs, 10 cases Group 2: Mild to moderate degree of hemorrhage. Fluid and blood replaced, 10 cases. Group 3: Hemorrhagic or septic shock state, 11 cases. The result of case analysis and change of vital sign after ketamine injection were as follows: 1. Physical status: Range of class of physical states in group 1, 2 and 3 were 1~3, 2~4 and 3~4 respectively, and 50% of group 1 and all cases of group 2 and 3 were emergency surgery. 2. Age distribution: The range of age distribution in groups 1, 2 and 3 was 23~62, 18~65 and 16~64 years old respectively. 3. Type of operation: In group 1, lobectomy, laparotomy and other operations were performed. Howrever in group 2 and 3, thoracotomy, laparotomy and other procedures were performed for hemostatic purposes. except one total hysterectomy for sepsis. 4. Premedicants: In one third of the total cases, mostly in group 1, secobarbital, meperidine or diazipam were: given. Atropire was given in 45% of the total cases, and 45%, mostly in group 2 snd 3, were not given any premedicants. 5. Anesthesia induction: Following preoxygenation, mastly in group 2 and 3, anesthesia was induced with ketamine (1~2 mg/kg) and intubation was done with succinylcholine, except for 3 cases in group 1. 6. Anesthesia maintenance: Ketamine as a sole anesthetic agent was given to 9 cases in operations of less than 1(1/2) hrs. duration. In other cases N2O or N2O with ether, halothane or methoxyflurane were administered according to the vital signs, and muscle relaxants (succinylcholine or gallamine) were given if necessary. 7. Duration of anesthesia: The range of duration of anesthesia in group 1, 2 and 3 was 40~360, 60~315 and 85~4845 min respectively. The average duration was 2.6, 2.5 and 4.3 hr in each group. 8. Blood and fluid replacement during anesthesia: The average blood replacement in each group was 259.6, 886.7 and 954.5 ml/hr for the entire surgical procedure, whole fluid replacement averaged 243.1, 228.0 and 432. 3 ml/hr respectively. 9. Hemoglobin: The range of Hb in preanesthetic state 8.2~14,9.5~12.8 and 7, 913.9 gm/dl in groups 1,2 and 3 and averaged 11 .8, 10.9 and 10.8. These Hb values increased after operation with blood and fluid to 12. 3, 11.0 and 12.3 gm/dl respectively. 10. Blood pressure: Before anesthesia the average systolic and diastolic Bp was 122.5/84.0, 94.5/68.0 and 108/79 mmHg in each group. Following the administration of ketamine, the systolic pressure increased 5.3, 14.3 and 26.7% respectively after 10 min. 11. Pulse rate: Change in pulse rate after ketamine injection was not significant in mast of cases. 12. Respiration: No remarkable change in respiration was observed however respiration was assiteded or controlled adequately through the anesthesia. With the above results, the rise of BP induced by ketamine during the induction period was found to be advantageous with such patients. We concluded that ketamine anesthesia for shocked patients of any etiology was safe, useful and satisfactory.
Age Distribution ; Anesthesia* ; Blood Pressure ; Emergencies ; Ether ; Halothane ; Heart Rate ; Hemorrhage ; Humans ; Hysterectomy ; Intubation ; Ketamine* ; Laparotomy ; Meperidine ; Methoxyflurane ; Respiration ; Secobarbital ; Sepsis ; Shock* ; Shock, Septic ; Succinylcholine ; Thoracotomy ; Vital Signs

Continuous epidural block was used for pain control during and after operation and for herpes zoster in two cases. A 63 year old male patient with herpes zoster on the right T 12 level for 2 weeks was treated by continuous epidural block. After 10 days, elective right inguinal hernioplasty was performed under epidural blocks by the previously inserted catheter. Postoperative pain and herpes zoster have been controlled in the same manner. Two weeks later, he was discharged without post-herpetic sequelae. The second case, a 82 year old man, was admitted with dysuria and also herpes zoster on the right T 10 level for 10 days. Using only continuous epidural block, suprapubic prostatectomy was done and post-operative pain was controlled. Two days later, the catheter was removed by the urological department. However, two weeks after operation, post-herpetic neuralgia developed and continuous epidural block was restarted for 2 weeks. Then epidural methylprednisolone injection, 2 times, and transcutaneous electrical stimulations were required for 3 more months for complete recovery. This indicated that continuous epidural block was beneficial not only for the treatment of herpes zoster but also for the prevention of post-herpetic neuralgia.
Catheters ; Dysuria ; Electric Stimulation ; Herniorrhaphy ; Herpes Zoster* ; Humans ; Male ; Methylprednisolone ; Neuralgia ; Pain, Postoperative ; Prostatectomy

The loss of Substantial portion of critically ill patient'a tidal volume through a broncho-pleural fistula may significantly alter the intrapulmonary distribution of ventilation, ventilation-perfusion matching and arterial blood gases. Prompt localization of surgical closure of bronchopleural fistu1a remains the treatment of Choice in most Patients. We had a chance to use a Univent tube with movable blocker to the patienta of breach-opleural fistula whith developed durinf esophageal bougienation. The endotracheal tube has two compartment, a large lumen for conventional air passage and a small lumen where a movable tube is placed. Intubation a accomplished by ordinary technique, advancement of the bronchial tube to the right lowers bronchus being guided by fiheroptic bronchoscopy.
Bronchi ; Bronchoscopy ; Critical Illness ; Fistula* ; Gases ; Humans ; Intubation ; Tidal Volume ; Ventilation

Transcutaneous oxygen and carbon dioxide tension (PtcO2 and PtcCO2) measured with a heated electrode was compared with arterial owygen and carbon dioxide tension (PaO2 and PaCO2) in 5 groups of 37 patients admitted to the Intensive Care Unit, Severance hospital, from October 1985 to February, 1986. The results were as follows 1) In the group I (6 neonate patients), the PtcO2 and PtcCO2 index was 0.89. 1.02. The relationship of the two method is given br the regreasion equation(in mmHg) : PaO2= 1.15 (PtcO2) +0.77(r: 0.86 P<0.001) PaCO2=0.87 (PtcCO2) +5.12(r: 0.91 P<0.001) 2) In the group 2(13 mpmsirgocal patients) the PtcO2 and PtCO2 index was 0.71, 1.03. The relationship of the two methods is given by the regression equation(in mmH7) : PaO2 = 1.42(7t707) -0.27 (r: 7.53 p<0.001) rac07=1.73 (7tc007) -7.43 (r: 0.74 p<0.001) 3) In the group 3(8 immediate postopen heart patients) PtCO2 index was 0.20, PtcCO2 index was 1.25. There was no correlation between PtcO2 and PaO2. The relationship of the two method is given by the regression equation(in mmHg) : PaCO2= 0.40(ftcCO2) +2l. 68(r: 0.60 p<0,005) 4) In the Group 4(9 postpen heart patient after extubation) PtCO2 & PtCO2 index was 0.60, 1.05, and the relationship of the two method is given by the regression equation (in mmHg): PaO2 =1.92 (PtcO2)+67.26 (r=0.68 P<0.001) 7aCO2=0.64 (PtcCO2)+14.87 (r=0.66 p<0.001) 5) In the group 5(COPD Patient) the Ptco2 and rtcc09 index was 0.84, 1.04. and th? relationship of the two method is given br the regression equation(in mmHg) PaO2 = 1,10 (PtcO2) +7.35 (r=0.81 p<0.001) PaCO2=0.52 (PtcCO2) +21.59 (r: 0.63 P<0.001) Continuous montiroing can reveal large fluctuations in PaO2 and PaCO2 which would be missed by the use of intermittent arterial samples. The transcutaneous electrode can be employed usefully in the neonate and hemodynamic-allr stable adult patient in Intensive Care Unit. However this method is not recommended to the patients in shock, immediate postoper-ative patient with peripheral vasoconstriction and poor perfusion.
Adult ; Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Electrodes ; Heart ; Hot Temperature ; Humans ; Infant, Newborn ; Intensive Care Units ; Oxygen ; Perfusion ; Shock ; Vasoconstriction

Feasibility and neurologic complications accompanying spinal anesthesia with variable specific gravities were examined in 56 lumbar disc operation from March 1977 to October 1978. Patients' age ranged from 21 to 36 years with 54 cases of males and 2 females. On myelography, lateral and partial blocks were observed in 50 cases and total blocks in 6 cases. These cases were classified depending on the specific gravity and local anesthetics as follows: .Isobaric group: a) 1% tetracain solution, ampule, mixed with C.S.F., 20 cases. b) tetracaine powder with C.S.F., 11 cases. c) 10% procaine solution with C.S.F., 9 cases. .Hyperbaric group: 1% tetracaine solution with 10% dextrose in water, 10 cases. . Hypobaric group: tetracaine powder with water, 6 cases. Under isobaric, hyperbaric and hypobaric spinal anesthesia, good to excellent results were obtained in 90, 90 and 16.6% respectively. More than 10% of systolic blood pressure fall after block was seen in 15, 90 and 16.6% respectively. No neurologic sequalae were observed. Isobaric spinal anesthesia with tetracaine solution is indicated as safer for recently herniated lumbar disc operations.
Anesthesia, Spinal* ; Anesthetics, Local ; Blood Pressure ; Female ; Glucose ; Humans ; Male ; Myelography ; Procaine ; Specific Gravity ; Tetracaine ; Water

The Intensive Care Unit(ICU) of Severance Hospital was opened on October 18, 1968 with 7 beds and expanded to 19 beds on February 2, 1981. Statistical analysis of ICU patients has already been reported twice: 1. from 1970 to 1977 with 3, 072 cases and 2. from 197S to 1981 with 4,348 cases The following is a clinical analysis of l,458 ventilator cases which comprise6 33.5% of the ICU patients from March 1975 to February 1982. Until 1979 pressure and volume cycled ventilators were use6 at an equal ratio; however, since 1980, volume-cycled ventilators such as the Bennett MA I and MA g and the Bourns LS 104-150 were mainly used. The ventilator cases from the Department of Internal Medicine and Cardiac Surgery rem-ained almost constant at a 30: 30 ratio from 1975 to 1977 However since 1978, the cardiac surgery ventilator cases increased to over 50% of the total. The number of ventilator cases below the ten yearold age group was 396 cases, about 27% of the total. They have increased year by year. Among 587 ventilator cases in 1981, the Bennett MA I and II were used, in 225 and 203 cases respectively. In the under 1 year old age group, 36 cases(43, 9%) were Put on with the Bourns LS 104- 150 and 30 cases(36.6%) on the Drager Babylog I respectively. 487(90.7%) cases were supp-orted with controlled mechanical ventilation(CMV) mode and 135(25%) with the positive end expiratory pressure (PEEP). Of 537 cases, 441(85%) was disconnected from the ventilator within 3 days. Death according to duration of ventilator support was 47(18. 8%), 38(23. 8%) and 14(36.9%) in 1, 2 and 10 days respecitively. But, for the period of 10-19 days, the number of deaths was 4(36.4%) and for 2p or more days 1 case(25%). Reosons for ventilator support were postcardiac operation (301cases, 56%) followed by CNS(central nervous system), IRDS(idiopathic respiratory distress syndrome), and lap- arotomy cases in that order. All ventilator cases with neuromascular disease survived bat none with DEC(Disseminated microvascular cosgulopathy) did. From the above results it can be concluded that ventilator support cases are increasing and the attendant mortality rate is decreasing year by year.
Humans ; Intensive Care Units* ; Critical Care* ; Internal Medicine ; Mortality ; Positive-Pressure Respiration ; Thoracic Surgery ; Ventilators, Mechanical*