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

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

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

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*

BACKGROUND: Accurate placement of double-lumen endobronchial tube(DLT) is essential for successful one-lung anesthesia. This study was performed to evaluate the effectiveness of bronchial cuff inflation technique for accurate placement of DLT. METHODS: One hundred and five patients undergoing elective thoracotomy which required the use of DLTs were studied. Following induction of anesthesia, the tip of the left-sided DLT was advanced just past the vocal cords, the stylet in the endobronchial lumen was removed and the tube was rotated 90 degrees counterclockwise. After rotation of DLT, the bronchial cuff was inflated with air(4-6 ml) and the tube was advanced until resistance to further passage was encountered. After deflating of the bronchial cuff, the tube was advanced 2 cm more distally. The fiberoptic bronchoscopy was then introduced into the tracheal lumen of the tube and the tube's position was evaluated. RESULTS: In the 100 patients out of 105 patients, the tube was inserted into the left side bronchus correctly. In the 77 patients(77 %) out of 100 patients, the position of DLTs was evaluated as ideally placed. In the 16 patients(16 %), the tube was evaluated as too deeply inserted into the appropriate bronchus and in the other 7 patients, the tube was too shallow. But only one patient needed repositioning. CONCLUSIONS: Bronchial cuff inflation technique may be useful for accurate placement of DLT for the one-lung anesthesia in the situation without fiberoptic bronchoscope.
Anesthesia ; Bronchi ; Bronchoscopes ; Bronchoscopy ; Humans ; Inflation, Economic* ; Thoracotomy ; Vocal Cords

BACKGROUND: This study was performed to accurately discover the correlation between the epidural depth and physical measurements. METHODS: We measured the L2-3, L3-4 epidural depth pre-marked on the needle shaft only when the block was successful. Correction of the depth was made by the angulation of the needle from the perpendicular line (with regard to both the x- and y-axis) to the skin. Height and weight from the medical record was noted and neck, waist, and hip circumferences of each subject was measured. Physical parameters such as waist/neck (waist circumference-to-neck circumference ratio), waist/height (waist circumference-to-height ratio), waist/hip (waist circumference-to-hip circumference ratio), weight/neck (weight- to-neck circumference ratio), weight/height (weight-to-height ratio) and body mass index (BMI) were calculated. Peason's correlation and a regression test between the epidural depth and the physical mea surements were performed. RESULTS: Significant correlation with epidural depth was found in weight, waist, hip, neck, BMI, waist/height, waist/hip, weight/neck, and weight/height. With the regression test, we found weight to be the most important for predicting epidural depth (R square = 0.330, P < 0.05). CONCLUSIONS: Weight has the highest predictive value for lumbar epidural depth.
Body Mass Index ; Hip ; Medical Records ; Neck ; Needles ; Skin

A central venous catheter is inserted through the subclavian vein for the purpose of administration of fluids and drugs, and the monitoring of the central venous pressure. Central venous catheterization is associated with complications that may occur during the insertion of the catheter or owing to the aberrant location of its tip. A malpositioned catheter can result in faulty central venous pressure reading or lead to thrombosis of the vein. Many attempts have been made to correctly place a central venous catheter into the superior vena cava. We report a case where the cephalad direction of the flexible end of a J type guidewire was related to the guidewire advancing into the internal jugular vein.
Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Central Venous Pressure ; Jugular Veins* ; Subclavian Vein ; Thrombosis ; Veins ; Vena Cava, Superior

Since the advent of positive-pressure mechanical ventilator in respiratory support, barotrauma has become a feared complication. Elevated peak airway pressure is one of the risk factors of barotrauma, so it has been tried how to change ventilator setting to minimize airway pressure. One method is to decrease tidal volume and increase respiratory rates. Therefore we studied changes of airway pressure, compliance and resistance of the total respiratory system according to change tidal volume and respiratory rates. We selected 23 patients over the age of 15 and with no respiratory problem. And we excluded patients received thoracic and abdomen surgery because airway pressure might be changed by surgical manipulation. The patients without premedication were ventilated during 5 minutes with 50% oxygen, N2O and isoflurane(1.0 vo1%) by closed circuit ventilator(Physio-Flex(TM)) after slow intravenous injection of thiopental sodium, fentanyl and vecuronium. Then we intubated with I.D. 8 mm sized endotracheal tube for men and with I.D. 7 mm for women. Minute ventilation(100 ml/kg), concentration of isoflurane(1.0 vo1%), gas flow rate and I:E ratio(1:2) were maintained constantly during controlled ventilation and we increased respiratory rates stepwise by 2 bpm from 8 to 24 bpm and decreased tidal volume to maintain minute ventilation. At 10 minutes after change of ventilator setting, we checked peak airway pressure, plateau airway pressure, arterial and end-tidal CO2 tension. And then we calculated compliance and resistance of the total respiratory system. Peak airway pressure and compliance decreased according to decreasing tidal volume and increasing respiratory rates, but arterial CO2 tension and resistance were not changed. We concluded that METHOD of decreasing tidal volume and increasing respiratory rates decrease peak airway pressure and keep minute ventilation to prevent hypercarbia.
Abdomen ; Arterial Pressure ; Barotrauma ; Compliance* ; Female ; Fentanyl ; Humans ; Injections, Intravenous ; Lung ; Male ; Oxygen ; Premedication ; Respiration, Artificial* ; Respiratory Rate* ; Respiratory System ; Risk Factors ; Thiopental ; Tidal Volume* ; Vecuronium Bromide ; Ventilation ; Ventilators, Mechanical