No abstract available.
Aneurysm, Infected* ; Endocarditis* ; Mesenteric Artery, Superior*

BACKGROUND: Anesthetic technique for laryngeal microscopic surgery should be focused on rapid recovery of deep anesthesia and full muscle relaxation. This study was taken to evaluate the effect of continuous infusion of propofol and succinylcholine for this kind of anesthetic goal. METHODS: Forty patients scheduled for laryngeal microscopic surgery of short duration(15 min) were randomly allocated into two groups. Anesthesia was induced and maintained with either propofol(2.5 mg/kg followed by a continuous infusion of 0.1 mg/kg/min) in group P or with thiopental (5.0 mg/kg) and inhalation of 1~2 vol % enflurane for maintenance of anesthesia in group T/E. Succinylcholine(1 mg/kg followed by continuous infusion of 0.1 mg/kg/min) was administered to facilitate tracheal intubation and maintain neuromuscular blockade. RESULTS: No significant difference of duration of anesthesia appeared between two groups. Additional doses of succinylcholine were needed in 10% of group P and 30% of group T/E (p<0.05). In group P, time to response to suction catheter(136+/-54 vs 232+/-116 sec), time to eye open spontaneously or to verbal commands (368+/-142 vs 549+/-165 sec) and time to extubation (454+/-117 vs 647+/-181 sec) were significantly shorter comparing to group T/E. The quality of awakening was more favorable in group P(p<0.05). Laryngeal suspension induced bradycardia in 15% of group P and in 5% of group T/E. Both group P and group T/E (10% vs 30%) needed esmolol infusion to control the blood pressure during surgical procedure. CONCLUSIONS: Rapid recovery of anesthesia and muscle relaxation can be expected after continuous infusion of propofol(2.5 mg/kg followed by 0.1mg/kg/min) and succinylcholine(1 mg/kg followed by 0.1 mg/kg/min) supplemented with 50% N2O in 50% O2 for short duration of laryngeal microscopic surgery.
Anesthesia ; Anesthetics ; Blood Pressure ; Bradycardia ; Enflurane ; Humans ; Infusions, Intravenous* ; Inhalation ; Intubation ; Muscle Relaxation ; Neuromuscular Blockade ; Nitrous Oxide* ; Propofol* ; Succinylcholine* ; Suction ; Thiopental

The recording of middle cerebral artery (MCA) flow veloeity by transcrsnisl Doppler technique offers s new, noninvasive, and continuous technique for studies of cerebral circu lation. The influence of changes in PaCO2 on MCA flow velocity were observed during hypothermic cardiopulmonary bypass(CPB) surgery by means of transcranial Doppler tech- niques. In ten patients who were undergoing hypothermic CPB surgery, the right MCA flow velocity was measured before initiation of CPB(prebypass period) and after the termination of CPB (postbypass period). During steady state CPB(constant hematocrit, constant temperature, and constant total pump flow), baseline MCA flow velocity(CPB I period) was measured and then repeated after specific alteration of PaCO2 achieved by changing of fresh gas flow to oxygenetors(CPB II period). And carbon dioxide reactivity defined as percent change of MCA flow velocity per mmHg changes in PaCO2 was observed during stable hypothermic CPB. MCA flow veocity showed no statistical difference between the prebypass value(56.9+/-13.5 cm/sec) and the postbypass value(64.7+/-29.7 cm/sec). PaCO2 of 20.5+/-2.5 mmHg was associated with MCA flow velocity of 25.2+/-10.1 cm/sec in the CPB I period while PaCO2 of 27.1+/-3.5 mmHg was associated with MCA flow velocity of 35.3+/-12.9 cm/sec. MCA flow velocity carbon dioxide reactivity during steady state hypothermie CPB was 6.68+/-2.26 %/ mmHg. These results have demonstrated that the response of MCA flow velocity to changes in PaO2 was well maintained during hypothermic CPB and the use of transcrsnial Doppler would give valuable results in the study of cerebral circulation during hypothermic CPB.
Blood Flow Velocity* ; Carbon Dioxide* ; Carbon* ; Cardiopulmonary Bypass* ; Hematocrit ; Humans ; Middle Cerebral Artery

The continuous perineural, perivascular compartment surrounding the brachial plexus from the tip of the cervical transverse process to the axilla may be entered at virtually any level, and the extent of anesthesia depends upon the level of entry and volume of local anesthetics injected. Various approaches of brachial plexus block were introduced to produce a successful block with the least complications. In this study, 25 ml of 0.5% bupivacaine hydrochloride solution was injected by subclavian perivasular approach to illustrate the effect of various locations of paresthesia on the distribution of analgesia in 50 patients who had an operation of the hand or forearm. The location of paresthesia evoked by insertion of a 23-gauge scalp needle during performance of brachial plexus block was checked at the distribution of the superior, middle, and inferior trunks. A pin prick test was performed at 15 min, 30 min and 45 min after injection of bupivacaine hydrochloride to evaluate the distribution of analgesia in the superior, middle and inferior trunk of the brachial plexus. The incidence of analgesia in all three trunks was the highest when paresthesia of the middle trunk distribution was elicited. The incidence of analgesia in the superior trunk distribution was significantly lower when inferior trunk paresthesia was elicited than when superior trunk paresthesia was elicited. Superior trunk paresthesia was the most frequently elicited. Complications were arterial puncture (32%), Horner's syndrome (8%) and hematoma (2%). The results indicates that brachial plexus block by supraclavicular subclavian perivascular approach is a relatively safe technique. Injection of local anesthetics following the confirmation of middle trunk paresthesia is desirable to obtain the successful block. Especially when analgesia of superior trunk distribution is required, the direction of needle insertion should be adjusted to avoid the inferior trunk paresthesia elicited.
Analgesia ; Anesthesia ; Anesthetics, Local ; Axilla ; Brachial Plexus* ; Bupivacaine ; Forearm ; Hand ; Hematoma ; Horner Syndrome ; Humans ; Incidence ; Needles ; Paresthesia ; Punctures ; Scalp

Pseudocholinesterase is known to be involved in the metabolism of succinylcholine, mivacurium, procaine, chloroprocaine, tetracaine, cocaine, heroin, and other drugs, although the physiologic function has not been well established. Prolonged neuromuscular block following administration of succinylcholine correlates with very low or genetically variant cholinesterase activity. The determination of pseudocholinesterase activity is of importance to the anesthetist in order to predict the susceptibility of the patient to the muscle relaxant, succinylcholine. The purpose of this study was to investigate the change of pseudocholinesterase level during cardiopulmonary bypass(CPB) for open heart surgery with hemodilution and hypothermia. Seven venous blood samples before induction of anesthesia(control), during CPB, and until the fifth postoperative day in 12 patients who underwent open heart surgery were taken. The pseudocholinesterase level was measured by Wako kit and JASCO UVIDEC 77 clinical spectrophotometer. The results were as follows ; 1) The control hematocrit was 40.32+/-6.21% and decreased to 23.72+/-1.86% immediately after the start of CPB(p<0.01) and to 22.42+/-1.93 % 30 minutes after the start of CPB(p<0.01). 2) The control pseudocholinesterase value of 1296.67+/-251.03 IU/L decreased to 915.67+/-228.16 IU/L immediately after the start of CPB(p<0.01), and to 727.83+/-197.58 IU/L 30 minutes after the start of CPB(p<0.01). 3) The mean values of pseudocholinesterase level immediately posteratively, on the first postoperative, and the third postoperative days were 1488.50+/-333.52 IU/L, 1913. 17+614.50 IU/L and 1620.92+/-458.82 IU/L, respectively, and those were significantly increased from the control value(p<0.05, p<0.01, and p<0.01, respectively). 4) The mean value of pseudocholinesterase level on the fifth postoperative day was 1392.25+/-271.69 IU/L, which was not significantly different from the control valule. 5) Transfused units of whole blood, packed red cells, and fresh frozen plasma were 2.8+/-1.4, 3.2 +/-1.0, 3.4+/-0.9, respectively.
Cardiopulmonary Bypass* ; Cholinesterases ; Cocaine ; Hematocrit ; Hemodilution ; Heroin ; Humans ; Hypothermia ; Metabolism ; Neuromuscular Blockade ; Plasma ; Procaine ; Pseudocholinesterase* ; Succinylcholine ; Tetracaine ; Thoracic Surgery

We studied the effect of stellate ganglion block on the mean blood flow velocity and carbon diaxide reactivity of the middle cerehral artery in nine healthy volunteers. Mean blood flow velocity of the right middle cerebral artery was measured under normocapnia and carbon dioxide reactivity to end-tidal PCO2 of 30 mmHg, 40 mmHg, and 50 mmHg was assessed before and after right stellate ganglion block. End-tidal PCO2 was controlled by hyperventilation and rebthing technique. Mean blood flow velocity was measured using transcranial Doppler sonography, and carbon dioxide reactivity was expressed as the percentage change in mean blood flow velocity per unit change in end-tidal PCO2. There was no difference in mean blood flow velocity under normocapnia (37.7+/-1.1 mmHg) between the values measured before stellate ganglion block (60.3+/-4.9 cm/sec) and the values measured after stellate ganglion block (58.6+/-4.9 cm). Mean blood flow velocity increased as end-tidal PCO2 increased from 30 mmHg to 40 mmHg, and from 40 mmHg to 50 mmHg (p<0.01) both before and after stellate ganglion block. Carbon dioxide reactivity of mean blood flow velocity did not change after stellate ganglion block. Heart rate decreased from 77.1+/-3.5 beats/min to 70+/-2.5 beats/min when end-tidal PCO2 was controlled from 30 mmHg to 40 mmHg after stellate ganglion block (p<0.05). Mean arterial blood pressure did not change after stellate ganglion block at any end-tidal PCO2 level. These results suggest that stellate ganglion block does not induce the change of mean blood flow velocity and carbon dioxide reactivity of the middle cerebral artery.
Arterial Pressure ; Arteries ; Blood Flow Velocity* ; Carbon Dioxide* ; Carbon* ; Healthy Volunteers ; Heart Rate ; Hyperventilation ; Middle Cerebral Artery* ; Stellate Ganglion* ; Ultrasonography, Doppler, Transcranial

PURPOSE: To study the unaffected fellow eye in patients with normal tension glaucoma and unilateral visual field defect in conventional white-on-white automated perimetry, using scanning laser polarimetry and frequency-doubling perimetry. METHODS: Thirty patients with a unilateral glaucomatous visual field defect detected on conventional perimetry (Humphrey field analyzer) were selected. The contralateral eyes with normal conventional perimetry results were studied using scanning laser polarimetry and frequency-doubling perimetry. Twenty eyes of 20 age- (+/-5 years), sex-, refractive error- (+/-2 D) matched persons without glaucoma were selected as a control group. RESULTS: Of the 30 contralateral eyes, 18 eyes (60%) showed a defect of the nerve fiber layer when evaluated with SLP. In the control group, 2 eyes (8.3%) showed a defect of the nerve fiber layer. Of the 20 contralateral eyes, 14 eyes showed abnormal FDP results. In the 17 control group, 2 eyes (2%) showed abnormal FDP results. CONCLUSIONS: These findings suggest that what appeared to be unilateral visual field defects by conventional white-on-white automated perimetry may in fact underestimate structural as well as functional glaucomatous damage in the contralateral eyes. These results may be important for early detection of glaucoma and future treatment.
Glaucoma ; Humans ; Low Tension Glaucoma* ; Nerve Fibers ; Scanning Laser Polarimetry ; Visual Field Tests ; Visual Fields*

PURPOSE: To present long-term results of intraocular pressure control and graft survival of eyes with penetrating keratoplasty(PKP) and Ahmed valve implant METHODS: We retrospectively reviewed medical records of 18 patients who underwent both PKP and Ahmed valve implant at Asan medical center between July of 1993 and June of 2000. Ahmed valve implant surgery was performed either before PKP (3 eyes), after PKP (12 eyes), or at the same time as PKP (3 eyes). Mean patient age was 40.7 years (range, 18 to 77 years) and mean follow up was 32 months (range, 5 to 120 months). Glaucoma outcome was assessed by postoperative intraocular pressure. Corneal outcome was assessed by graft rejection, failure and visual acuity. RESULTS: The average preoperative intraocular pressure for all of the eyes was 35 mmHg. Eighty nine percent of them (16 eyes) achieved a final intraocular pressure of less than 20 mmHg (average, 15 mmHg on a mean of 0.9 medications). Graft failure occurred in 13/16 (72%). The overall PKP success rate, including the eyes that underwent repeat PKP, was 44 %. Visual acuity improved in 8 eyes, remained stable in 5 eyes and decreased in 5 eyes. CONCLUSIONS: Ahmed valve implant can successfully control glaucoma in a majority (89%) of PKP eyes. However, the success of corneal grafts is relatively low (44%).
Chungcheongnam-do ; Follow-Up Studies ; Glaucoma ; Graft Rejection ; Graft Survival ; Humans ; Intraocular Pressure ; Keratoplasty, Penetrating* ; Medical Records ; Retrospective Studies ; Transplants ; Visual Acuity

BACKGROUND: Obtaining and utilizing the feed-backs from residents who have finished four year of anesthesia residency could well contribute to improvement in training program. Therefore authors have designed a self questionnaire to analyze the degrees or measures of satisfaction from such training program and data were evaluated to provide,in future,the guideline which would improve the quality of the training program. METHODS: The self-questionnaires were sent to residents(n=148),who have been through the entire four year of residency training courses under anesthesia department. The assessment was conducted to measure the degree of satisfaction based on several variables such as motivation, selection of anesthesiology as a first choice, type of training hospital, and sex. To evaluate the current problems of anesthesia residency program, we made 30 open-ended and close-ended questions. Data analysis was made using Fishers exaet test. RESULTS: There were no statistically significant difference between the degree of satisfaction and their motivation for choosing anesthesia, anesthesia as a major, selection of anesthesiology as a first choice, and types of hospitals. As for the difference in satisfaction of training, male residents showed significantly higher satisfaction rate( n=92, 36.2%) than female residents(n=47, 17%). CONCLUSIONS: These results suggest that degrees of satisfaction was more likely related to the program of each training hospital and sex compared to other variables studied.
Anesthesia Department, Hospital ; Anesthesia* ; Anesthesiology ; Education ; Female ; Humans ; Internship and Residency* ; Male ; Motivation ; Surveys and Questionnaires ; Statistics as Topic

To determine the accuracy of end-tidal PCO2(PetCO2) measurement analysed with Ohmeda 5210 capnometer in the pediatric patients whose jung were ventilated with Ohio infant Circle Absorber and Ohio Ventilatior 7200, we compared PetCO2, measurements sampled from the proximal(PetCO2-p) and distal(PetCO2-d) ends of the tracheal tube to arterial PCO2(PaCO2) in 22 healthy pediatric patients between 6.8 to 18.5kg. The results were as follow: 1) Proximal PetCO2 and distal PetCO2 correlated with PaCO2(r=0.76%, SEE=2.79, r=0.70:SEE=3.01, respectively)(p<0.05). 2)Arterial to end-tidal PCO2 difference(delta(a-et)PCO2) was significantyly greater with distal(3.53+/-4.68 mmhg) than proximal(0.35+/-2.72 mmhg) sampling(p<0.05). 3) In subgroup of patients whose proximal to distal concentration of nitrous oxide difference was more than 2%, the delta(a-et)PCO2 using distal sampling(7.90+/-5.15 mmhg) was also significantly greater then it was using proximal sampling(-1.73+/-2.39 mmhg)(p<0.05).. We conclude that distal estimates of PetCO2-P can not provide accepatbale estimate of PaCO2 in healthy pediatric patients who are intubated with pediatric uncuffed tracheal tube.
Carbon Dioxide* ; Carbon* ; Humans ; Infant ; Nitrous Oxide ; Ohio