BACKGROUND: This study was performed to discover how much needle deflection occurs during spinal or epidural block and how it can be reduced. METHODS: A styrofoam block was used to simulate the paraspinal area of the back. A line was drawn perpendicular to the edge. Using the line as a guide, the needles were advanced through the block. Quincke-type needles of 22 and 25 gauge, pencil-type needles of 22 and 25 gauge or Tuohy needles of 17 and 18 gauge were used. Using a block of 6 cm thick, spinal needle was advanced through the introducer with their apertures facing to the same or opposite direction. The deflection from the perpendicular line was measured in mm intervals. RESULTS: Small-gauged and beveled spinal needles had more deflection depending on the block thickness (P < 0.05). However, the deflection of epidural needles was not consistent. When the bevel of the introducer and spinal needle was facing the same direction, the use of an introducer needle decreased the deflection in 22 and 25 G Quicke, and 25 G Whitacre needles (P < 0.05). When facing each other, the deflection was reduced in all the spinal needles (P < 0.05), and reduced more in the 25 G Quicke needles (P < 0.05). CONCLUSIONS: Considering the estimated depth of the spinal canal, needle type, bevel direction, its gauge and the use of an introducer needle, we can take advantage of the deflection phenomenon to reduce post-dural puncture headache and to increase the success rate of a spinal or epidural block.
Needles* ; Post-Dural Puncture Headache ; Spinal Canal

Uncontrolled or inadequately controlled postoperative pain may lead to delayed recovery from surgery, pulmonary complications, and restriction of mobility leading to increased risk of thromboembolism. Standardized regimens for pain management can lead to safer and better pain control. Of these regimens, patient-controlled analgesia, a delivery system with which patients self-administer small, predetermined analgesic doses, produced improved pain relief, greater patient satisfaction, less sedation, and fewer postoperative complications. Anesthesiologists have played an important role to make this pain management feasible. The introduction of acute pain services at hospitals prompted improvements in postoperative pain management in addition to the minimization of related complications.
Analgesia* ; Analgesia, Patient-Controlled ; Humans ; Pain Clinics ; Pain Management ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Complications ; Thromboembolism

We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

We experienced a case of open heart surgery for correction of ventricular septal defect and patent ductus arteriosus in five years old boy with hemophilia A. Factor VIII activity in this patient was 0.7% of normal activity. He received 2,000 unit of factor VIII intravenously for loading dose and has been infused 6 unit/kg/hour for 12 hours before the operation. And his factor VIII activity was 68% in the morning of the operation day. During the operation, he received 6 unit/kg/hour of factor VIII. After intracardiac anomaly was repaired and protamine was injected, we administrated 1000 unit of factor VIII. At that time, his factor VIII was 57%. After operation was done, he received 6 unit/kg/hour of factor VIII during stay in ICU and postoperative 14 days. His factor VIII activity was maintained at 36~104% during stay in hospital. So we report a successful case of perioperative management for the open heart surgery in patient with hemophilia A.
Ductus Arteriosus, Patent ; Factor VIII ; Heart Septal Defects, Ventricular ; Heart* ; Hemophilia A* ; Humans ; Male ; Thoracic Surgery*

INTRODUCTION: One-lung ventilation (OLV), as a model for adult respiratory distress syndrome, was performed in 8 mongrel dogs, which were made a little hypoxemic by adjusting inspired fraction of oxygen (FIO2) in order to know the effect of nitric oxide (NO) on cardiopulmonary hemodynamics and oxygenation during OLV in lateral position. METHODS: Double-lumen endobronchial tube was intubated through tracheostomy. OLV was performed in lateral position by turning to the side where Swan-Ganz catheter tip was located. FIO2 was adjusted to set SpO2 around 85~90%. After stabilization, cardiopulmonary hemodynamic variables and various oxygenation-related parameters were measured respectively at 5 steps: 1) OLV, 2) OLV and 20 PPM of NO inhalation, 3) OLV, 4) OLV and 40 PPM of NO inhalation, 5) OLV. NO (titrated in N2 tank at concentration of 800 PPM) was administered through low-pressure inlet of ventilator and diluted by inspiratory fresh gas. FIO2 setting of ventilator was slightly increased during NO administration to compensate for FIO2 decrease due to NO titration gas (N2) mixing. NO and NO2 concentration was monitored at the inspiratory limb of breathing circuit by a electrochemical analyzer. RESULTS: There were no difference about hemodynamic variables such as blood pressure (BP), pulmonary arterial pressure (PAP), heart rate (HR), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP). Neither were different calculated hemodynamic variables such as systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), pulmonary perfusion pressure (PPP), cardiac index (CI), and right ventricular stroke work index (RVSWI). PaO2/FIO2, AaDO2, and S/T were significantly different between step 3 and step 4. But other oxygenation-related parameters such as O2, O2 flux, and O2 ER extraction ratio were not different. CONCLUSIONS: NO inhalation may have a potential for relieving hypoxemia during OLV of dogs in lateral position.
Animals ; Anoxia* ; Arterial Pressure ; Bays ; Blood Pressure ; Catheters ; Central Venous Pressure ; Dogs* ; Extremities ; Heart Rate ; Hemodynamics* ; Inhalation ; Nitric Oxide* ; One-Lung Ventilation ; Oxygen* ; Perfusion ; Pulmonary Wedge Pressure ; Respiration ; Respiratory Distress Syndrome, Adult ; Stroke ; Tracheostomy ; Vascular Resistance ; Ventilators, Mechanical

An animal model was used to study the effects of normobaric hyperoxia on pulmonary mechanics and histopathology. Thirty two rats (227+/-46gm) were divided into control (Group 1) in room air and 3 hyperoxic groups (n=8, each). Hyperoxic groups breathed F1O2 0.98 for 24 hr(Group 2), 48 hr(Group 3), and 72 hr(Group 4), respectively. After hyperoxia, rats were intubated through tracheostomy, and inflation and deflation compliances of lung-thorax [CLT(I), CLT(D)] were calculated. Body weight(BW) was measured, and lungs were removed and weighed(LW). The lung specimens were examined microscopically. At the 3rd day of hyperoxia, 5 of 8 rats were died (63% mortality). CLT(I) of Group 4 was low (p<0.05) compared with others, and CLT(D) of all hyperoxic groups were low (p<0.05) compared with control. Mean LW/BW (lung weight divided by body weight) was elevated (p<0.05) in Group 3 and Group 4. Pulmonary pathologic findings such as inflammation, congestion, alveolar and bronchial wall damage, pulmonary edema etc. became apparent (p<0.05) at the 3rd day. We conclude that during hyperoxia pulmonary compliance might be decreased and lung weight might be increased progressively, and pulmonary pathological appearance of normobaric hyperoxia (F1O2 > 0.98) resemble those of adult respiratory distress syndrome (ARDS).
Animals ; Compliance ; Estrogens, Conjugated (USP) ; Hyperoxia* ; Inflammation ; Inflation, Economic ; Lung* ; Mechanics ; Models, Animal ; Pathology ; Pulmonary Edema ; Rats* ; Respiratory Distress Syndrome, Adult ; Tracheostomy

BACKGROUND: Exposure to hyperoxia causes extensive injury to lung tissue, which resembles the pathologic changes of the adult respiratory distress syndrome. To observe the relationship between the pulmonary oxygen toxicity and duration of exposure to oxygen, 100% oxygen was exposed to Wistar rats. METHODS: 35 rats were partitioned into 5 groups (n=7 in each group). Gr. I breathed room air. Gr. II, III, IV and V were exposed to 99~100% oxygen for 24 hrs, 48 hrs, 60 hrs and 72 hrs. Wet lung/body weight (WW/BW), dry lung/body weight (DW/BW), wet/dry lung weight (WW/DW) and I-albumin flux ratio were measured in each group. RESULTS: After exposure for 72 hrs in Gr. V, 3 rats were dead. WW/BW in Gr. I was 0.69+/-0.04 and increased to 1.10+/-0.28 in Gr.II (P<0.05), which was maintaind until 60 hrs. It showed marked increase in Gr. V; 2.16+/-0.60. DW/BW, WW/DW and I-albumin flux ratio increased after 48 hrs of hyperoxia. WW/BW and DW/BW in Gr. V and I-flux ratio in Gr. IV showed significant increase compared with Gr. I, II and III. CONCLUSIONS: The results suggest that pulmonary capillary permeability begins to change after 24 hrs of hyperoxia and that definite permeability change to albumin and fluid accumulation in the lung are demonstrable from 48 hrs-exposure to 99~100% oxygen and aggravated by duration of oxygen exposure.
Animals ; Capillaries* ; Capillary Permeability* ; Hyperoxia ; Lung ; Oxygen* ; Permeability ; Rats* ; Rats, Wistar ; Respiratory Distress Syndrome, Adult

BACKGROUND: Subclavian cannulation is useful for the patients who need long-term maintenance of central venous catheters, but the inadequate location of catheters produces some complications. In pediatric populations, the abnormal placement of subclavian catheters in the internal jugular vein (IJV) is frequent because the angle formed by the subclavian vein and IJV is much larger than in adults. We would therefore propose a technique which will increase the location ratio of subclavian catheters in the superior vena cava (SVC). METHODS: One hundred twenty three patients who received elective or emergent operations were divided into 4 groups which consisted of the 'neck rotation away from the cannulation site' group (RA), 'neck rotation toward the cannulation site' group (RT), 'neck tilt away from the cannulation site' group (TA), 'neck tilt toward the cannulation site' group (TT). We cannulated each group and verified the location of the catheter tip in chest PA for each group. RESULTS: The calculation for the ratio of SVC location to the total cannulation of each group (%SVC) was done and the X2 test was done. Total %SVC was 73.2% and %SVC of each group were 64.9% for the RA group, 77.3% for the RT group, 61.8% for the TA group, and 93.3% for the TT group. A considerable difference was found for total %SVC in the X2 test. The location ratio of the TT group was higher than the others and there was no difference found between the RA, RT, TA groups. CONCLUSIONS: We can conclude that tilting the neck toward the cannulation site would produce a higher ratio of SVC location of the subclavian catheter than other neck positions.
Adult ; Catheterization* ; Catheters* ; Central Venous Catheters ; Humans ; Jugular Veins ; Neck ; Subclavian Vein ; Thorax ; Vena Cava, Superior*

Thoracic epidural analgesia is the most effective method of managing post-thoracotomy pain. However, the catheter may be misplaced into the intrapleural, intercostal, subarachnoid, or intravascular space. Intravascular misplacement of a catheter can be detected by aspiration of blood or administration of a test dose of local anesthetic; however, these methods may result in a false-negative response. Moreover, a catheter placed in the epidural space may migrate into a blood vessel during the intraoperative period. Thus, the location of the catheter tip should always be determined before local anesthetic is administered. We report a case of intraoperative intravascular migration of a thoracic epidural catheter in a 32-year-old male who underwent left thoracotomy.
Analgesia, Epidural ; Blood Vessels ; Catheters ; Epidural Space ; Glycosaminoglycans ; Humans ; Intraoperative Complications ; Intraoperative Period ; Male ; Punctures ; Thoracotomy

BACKGROUND: Besides prostacyclin and nitric oxide, the endothelium-derived hyperpolarizing factor (EDHF), which is another distinct endothelium-dependent vasodilator, is involved in relaxing the vascular smooth muscle cells. The myoendothelial gap junction (MEGJ) and female sex hormone play important roles in the EDHF-mediated responses. Therefore, this study was designed to determine the influence of gender on the gap junctional distribution and endothelium-dependent vasodilation in the rat mesenteric arteries. METHODS: Male and female Sprague-Dawley rat were euthanized and the tertiary branch of the mesenteric artery was harvested. Immunohistochemistry and confocal microscopic examination of the arterial wall were performed after treating them with specific antibodies to delineate the distribution of connexin 43, a gap junctional protein. Segments of the mesenteric artery, 5 mm in length, were connected to two tungsten wires under isometric tension. The arterial segments were suspended in a modified Krebs solution (37 degrees C) aerated with 95% O2 and 5% CO2 in a vertical water-jacketed temperature-controlled tissue bath. The standard dose-response curve for acetylcholine (10(-9)-10(-5) M) was drawn in the presence of the NO synthase inhibitor, N(omega)-nitro-L-arginine methyl ester (L-NAME; 10(-4) M) plus indomethacin (10(-5) M) and/or gap junctional inhibitor, carbenoxolone (10(-4) M). RESULTS: In the female rat mesenteric artery, the gap junctional plagues were more prevalent particularly along the endothelial layer. The inhibition of the relaxation response to acetylcholine was depressed in the presence of L-NAME plus indomethacin and augmented in the presence of carbenoxolone when compared with the male rat mesenteric arteries (P < 0.05). CONCLUSIONS: Gender differences in the rat mensenteric arteries have an effect on the expression of connexin 43 and the release of EDHF through MEGJ may play a key role in controlling the female arterial tone.
Acetylcholine ; Animals ; Antibodies ; Arteries ; Baths ; Carbenoxolone ; Connexin 43 ; Dilatation* ; Epoprostenol ; Female ; Gap Junctions ; Humans ; Immunohistochemistry ; Indomethacin ; Male ; Mesenteric Arteries* ; Muscle, Smooth, Vascular ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Rats* ; Rats, Sprague-Dawley ; Relaxation ; Tungsten ; Vasodilation