PURPOSE: Perinatal asphyxia occurring in newborn is one of the major causes of acute mortality and chronic neurological disability in survivors. We have studied the relationship between early electroencephalography(EEG) findings and clinical course and neurologic outcome in severe asphyxiated neonates. METHODS: Between the period of July 1999 and June 2002, 25 neonates who were diagnosed with severe perinatal asphyxia(1-minute Apgar score of < or =3 and initial pH is less than 7.2) at NICU in Dongsan Medical Center were enrolled. An EEG was recorded and analyzed within three days of life and divided into two groups - group 1(normal or focal change on EEG) and group 2(generalized abnormal EEG). Between the two groups, clinical courses and neurologic outcomes were compared. RESULTS: Fifteen infants(60%) were group 1 and ten infants(40%) were group 2(polyspikes, burst- suppression, generalized low voltage). Associated maternal disease, days of hospitalization, need for ventilator support, delay of oral feeding and convulsion duration are significantly higher and longer in group 2. Also, poor neurologic outcome(expire, developmental delay) was significantly higher in group 2(60%) than group 1(13.3%). CONCLUSION: Thus, the early neonatal EEG in asphyxiated newborn can be a predictable diagnostic tool in assessment of neurologic outcome.
Apgar Score ; Asphyxia ; Electroencephalography ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Mortality ; Seizures ; Survivors ; Ventilators, Mechanical

BACKGROUND: Mannitol is widely used in neurosurgical patients and may induce an increase in serum potassium concentration according to doses and administration rates with unknown mechanism. The treatment of hyperkalemia is aimed at eliminating the causes and includes calcium, sodium bicarbonate, glucose with insulin, loop diuretics and hyperventilation. This study was undertaken to observe the effects of hyperventilation on the serum potassium concentration following infusion of mannitol (2.0 gm/kg). METHODS: We studied 30 patients who were operated brain aneurysm clipping surgery and were divided into 3 groups (n=10). In control group, mild hypocapnia was maintained (PaCO2, 32 2 mmHg) before and after mannitol infusion. In group I, moderate hypocapnia was maintained (PaCO2, 27 2 mmHg) before and after mannitol infusion. In group II, mild hypocapnia (PaCO2, 32 2 mmHg) was maintained before 30 minutes of mannitol infusion and moderate hypocapnia (PaCO2, 27 2 mHg) after mannitol infusion. We started infusion of 20% mannitol with a dosage of 2.0 gm/kg, 15~20 min after cranium was opened. RESULTS: The changes of serum potassium were as follows (Mean SD mEq/l) (just before and 15min, 30min, 60min after mannitol infusion): 3.79 0.48, 4.66 0.60, 4.44 0.48, 4.13 0.40 (Control group), 3.62 0.18, 3.63 0.42, 4.14 0.51, 3.95 0.33 (Group I), 3.76 0.20, 3.91 0.15, 4.11 0.30, 4.04 0.23 (Group II). After 15 minutes of mannitol infusion, the serum potassium levels of group I and II were lower than that of control group (p<0.05) and there was no significant difference between group I and II. CONCLUSIONS: These results suggest that hyperventilation may blunt the increase in serum potassium concentration following rapid infusion of high dose mannitol.
Calcium ; Glucose ; Humans ; Hyperkalemia ; Hyperventilation* ; Hypocapnia ; Insulin ; Intracranial Aneurysm ; Mannitol* ; Potassium* ; Skull ; Sodium Bicarbonate ; Sodium Potassium Chloride Symporter Inhibitors

The need for a short-acting non-depolarizing neuromuscular blocking agent to replace succinylcholine chloride(succinylcholine) is recognized widely and attempts to find such a drug have been numerous. Atracurium besylate(atracurium) is one of the new series of neuromuscular blocking agents with little cardiovascular effect and is not dependent on hepatic and renal function for terminating its action because of its self-destroying mechanism. Because succinylchline may occasionally be contraindieated for intubation in parturients we studied the use of atracurium in 23 patients having cesarean section. All patients received 0. 5 mg/kg atracurium for intubation and neuromuscular relaxation. Hemodynamic changes, the time from the injection of atracurium to maximal twitch suppression, the time between atracurium administration and the return to 10% of control twitch height were recorded and observed the degree of vocal cord relaxation and conditions of intubation and evaluated the Apgar scores. 1) Mean arterial pressure and heart rate increased significantly after intubation compared with that of control and just before intubation but there were no significant changes in 5 minutes after intubation. 2) The 90% twitch suppression following atracurium administration was 75.6+/-20.9 seconds. 3) The return of 10% of control twitch height was 2449.3+/-1114.0 seconds. 4) Intubation conditions were excellent for 19 patients. 5) The Apgar scores of 20 neonates were high. These data suggest that the use of atracurium may be a useful alternative for induction for Cesarean section when succinylcholine is contraindicated.
Arterial Pressure ; Atracurium* ; Cesarean Section* ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pregnancy ; Relaxation ; Succinylcholine ; Vocal Cords

To compare the time course of neostigmine and pyridostigmine antagonism of profound neu- romuscular blockade (no-twitch: when no response to peripheral nerve stimulation could be elicited) induced by vecuronium, the authors studied 30 patients who were ASA Physical Status I or II undergoing minor surgery, free from neuromuscular, renal or hepatic dieases. Train-of Four[TOF] stimulation was applied to the ulnar nerve every ISseconds and the force of contraction of adductor pollicis muscle was recorded. In all patients, anesthesia was induced with thiopental sodium(5 mg/kg) and vecuronium (0.1 mg/kg), endotracheal intubation was performed at 100% depression of the T1(the first response in the train-of-four sequence). Patients were randomly assigned to one of two groups Five minutes after intubation, when there was no detectable twitch response, each patient received either neostigmine(0.03 mg/kg) with atropine sulfate(0.02 mg/kg). Neuromuscular fuction in another ten subjects were allowed to recover spontaneously. The results were as follows; 1) Profound neuromuscular blockade was not rapidly antagonized by either neostigmine or pyridostigmine but the use of anticholinesterase was effeetive for recovery. 2) The results demonstrated that there were no difference in antagonism of vecuronium induced profound neuromuscular block between neostigmine and pyridostigmine. 3) The time to 100% depression of T1 after vecuronium injection was 190.5+/-38.7 sec. 4) After anticholinesterase administration, in all groups, the changes of mean arterial pressure and heart rate were within +/-10% of control after anticholinesterase dministration were observed.
Anesthesia ; Arterial Pressure ; Atropine ; Depression ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal ; Neostigmine* ; Neuromuscular Blockade ; Peripheral Nerves ; Pyridostigmine Bromide* ; Surgical Procedures, Minor ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide*

There is increasing tendency to use epinephrine injection or topical application to obtain clear operative field and hemostasis under general anesthesia. But excessive catecholamines due to inadvertent administration are known to cause a wide spectrum of cardiotoxicity. The authors have experienced a case of reversible cardiomyopathy due to accidental epinephrine overdose during mastoidectomy. This report is the first recorded case of the nearly fatal conseguences of inadvertent administration of a very large dose of epinephrine, with the subsequent development of a severe catecholamine induced "cardiomyopathy". After the initial phase of massive catecholamine excess, this patient required exogenous catecholamines to support the injured, dysfunctional myocardium and maintain adequate perfusion pressure to vital organs. These abnormalities are also transient in nature with complete recovery documented. The case suggests the need for aggressive support of patients received accidental epinephrine overdose with the expectation that, while cardiar. function may be extremely impaired early in the course of the illness, recovery is virtually complete over time.
Anesthesia, General ; Cardiomyopathies ; Catecholamines ; Epinephrine* ; Hemostasis ; Humans ; Myocardium ; Perfusion ; Ventricular Fibrillation

BACKGROUND: This study was purposed to study the therapeutic value of intraluminal oxygen insufflation on the oxygenation of gut mucosa in a feline model subjected to a hemorrhagic shock followed by reperfusion. METHODS: Eighteen cats were divided into three groups : For group 1, 6 cats were subjected to sham operation as a control group ; for group 2, 6 cats were subjected to a hemorrhagic shock for 2 hours prior to reperfusion as a hemorrhagic shock(HS) group ; for group 3, 6 cats were subjected to a simultaneous insufflation of intraluminal oxygen, continued during the shock and reperfusion periods as a oxygenated hemorrhagic shock(OHS) group. Mesenteric PvO2, mesenteric venous arterial(v-a) lactate difference, mesenteric P(v-a)CO2 and mesenteric pH(a-v) were measured for every 30 minutes during the shock and reperfusion. RESULTS: The lactate(v-a) was increased during the shock. For group OHS, the lactate(v-a) returned to the baseline value after reperfusion, but for group HS, it did not return. The values of pH(v-a) and P(v-a)CO2 were increased during the shock and returned to the baseline value for group OHS, but for group HS, the increase was greater than group OHS(p<0.05), but not returned to the baseline value after reperfusion. For both pH(v-a) and P(v-a)CO2, there were statistically significant differences(p<0.05) between group HS and group OHS during the shock and reperfusion. CONCLUSIONS: We conclude that the insufflation of intraluminal oxygen improves the oxygenation of gut mucosa in the feline model undergone a hemorrhagic shock followed by reperfusion.
Animals ; Cats* ; Insufflation* ; Lactic Acid ; Mucous Membrane* ; Oxygen* ; Reperfusion ; Shock ; Shock, Hemorrhagic

Fascioliasis is a zoonotic disease caused by Fasciola hepatica, a liver fluke, for which human acts as an accidental host. Fascioliasis, while common in some tropical countries, is rare in Korea. Endoscopie retrograde cholangiopancreatography(ERCP) has been described in only a very few cases as a useful technique for the diagnosis of fascioliasis. We report a case of fascioliasis diagnosed by ERCP, after endoscopic sphinchterotomy adult worms were removed by Dormia basket.
Adult ; Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis ; Fasciola hepatica ; Fascioliasis* ; Humans ; Korea ; Pancreas* ; Sphincterotomy, Endoscopic ; Zoonoses

PURPOSE: To determine the relation between the initial plasma cytokine response and the neurological prognosis in term infants with severe fetal distress. METHODS: Infants with severe fetal distress at birth (n=23) were studied prospectively. Cytokine concentrations were measured from umbilical cord blood at 3 and 12 hours of life by enzyme-linked immunosorbent assays for interleukin (IL)-1beta, IL-6, and IL-18. The study groups were divided into good (n=14) or poor prognostic group (n=9) according to survival and presence of cerebral palsy (CP) later and correlations with afore mentioned cytokine levels were determined. RESULTS: Cord blood IL-1beta and IL-18 concentrations were similar in both groups. However, infants with poor prognosis had significantly higher median (range) IL-6 concentration than infants with good prognosis at 3 hours [323.6 (32.6-812.8) vs. 38.4 (6.3- 322.7) pg/mL] (P=0.001), and 12 hours of life [287.1 (16.4-769.1) vs. 66.2 (8.8-757.8) pg/mL] (P<0.05). Significant higher IL-6 levels greater than 200 pg/mL were observed at 3 hours (P=0.005) and at 12 hours of life (P=0.023) for poor prognosis group. CONCLUSION: There was a significant correlation between neurologic outcome and plasma IL-6 levels. Higher concentrations of IL-6 (>200 pg/mL) may be a useful indicator of poor neurological outcome in infants with severe fetal distress.
Cerebral Palsy ; Enzyme-Linked Immunosorbent Assay ; Fetal Blood ; Fetal Distress* ; Humans ; Infant ; Infant, Newborn* ; Interleukin-18 ; Interleukin-6 ; Interleukins ; Parturition ; Plasma ; Prognosis ; Prospective Studies

Emergency surgical patients are more frequently in critical state than elective patients and they have not enough time for physical and laboratory examinations. The evaluation of perio-perative data will improve the outcome of emergency operation. We analyzed 1053 anesthesias for emergency operation which were performed at the department of anesthesiology, Anam Hospital from September 1992 to August 1993 clinically and statistically according to age, sex, physical status, department, anesthetic duration, method and agent, types of trauma, amount of transfusion, etc. The results were as follows; 1) The percent of emergency surgery cases was 13.6 of total surgical patients. 2) The ratio of male to female was 1.15:1. 3) About 61.1% of all emergency patients were in the 21-40 years age group. 4) According to the ASA classification of physical status, the percent of patients in emergency class 1 and 2 was 86.2 of the total patients. 5) The most common operation was Cesarean section (19.9%), and appendectomy (13.8%) the next. 6) The most common anesthetic method for emergency operation was general anesthesia with enflurane. 7) The obstetric cases were most common and the general surgery cases were the next. 8) The percent of the cases which took less than 2 hours duration was 82.4 of total operation. 9) The transfusion was done in 108 cases (10.3%) and less than 2 units was transfused most frequently. 10) The transference to ICU was done in 144 (13.7%) cases and the patients of general surgery were transfered to ICU most frequently. 11) The majority of injuries were classified as blunt trauma (86.6%) while 13.4% were classified as penetrating trauma. 12) The lagest number of injuries involved the upper extremity (47.8%) and the next was the head & neck (31.9%).
Anesthesia* ; Anesthesia, General ; Anesthesiology ; Appendectomy ; Cesarean Section ; Classification ; Emergencies* ; Enflurane ; Female ; Head ; Humans ; Male ; Neck ; Pregnancy ; Upper Extremity

Combined anesthesia has been associated with less sedation, earlier ambulation, higher pulmonary flow rates, improved oxygenation, blunting of stress response and better pain control in the postoperative period than general anesthesia. Total intravenous anesthesia has many advantages compared with inhalation anesthesia, but also has several disadvantages such as hypertension, inappropriate anesthetic, delayed recovery and emergence delirium For improvement of this problems, the authors tried epidural anesthesia combined with continuous intravenous infusion of propofol which is a short acting intravenous anesthetic and has characteristics of rapid and clear-headed recovery. Fifty-three patients undergoing elective thoracic operation were randomly assigned to receive anesthesia with N2O-O2-enflurane (n=23), epidural anesthesia combined with N2O-O2-propofol infusion (3 mg/kg/hy; n=15), or epidural anesthesia combined with medical air-O2-propofol infusion (6 mg/kg/hy; n=15). We studied the hemodynamic changes and occurence of awareness and recovery time on those three groups. Although there were significant changes in the hemodynamics among the groups except CVP, but all values were within normal limit and there were no difference in the recovery time. We concluded that epidural anesthesia with medical air-O2-propofol infusion (6 mg/kg/hr) is acceptable altemative method for thoracic surgery.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Delirium ; Hemodynamics ; Humans ; Hypertension ; Infusions, Intravenous* ; Oxygen ; Postoperative Period ; Propofol* ; Thoracic Surgery* ; Walking