Pulmonary artery sling is a rare congenital condition in which the left pulmonary artery arises anomalously fmm the right pulmonary artery extrapericardially and encirdes the right main stem bronchus and passes between the trachea and esophaghus to reach the hilum of the left lung. Respiratory obstruction vesults from compression of the lower area of trachea and right main stem bronchus. It is rare cause of respiratory distress in the new bom and may be associated with significant morbidity and mortality. We experienced the case of pulmonary artery sling with diffuse trachea stenosis and congenital heart disease (pulmonary atresia and PDA) and confirmed the anomaly by bronchogram and MRI. The presumed cause of death was respiratory obsruction due to pulmonary artery sling.
Bronchi ; Cause of Death ; Constriction, Pathologic ; Heart Defects, Congenital ; Lung ; Magnetic Resonance Imaging ; Mortality ; Pulmonary Artery* ; Trachea ; Tracheal Stenosis*

Dilutional hyponatremia as one of the postoperative complications shows around 0.34% in pediatric patients, of which iatrogenic administration of salt-free water is the major cause. Aggressive management should be performed if neurologic symptoms and signs coexist. He/she may be expired of respiratory arrest in severe cases, or permanent neurologic sequelae might persist. We report a case of female pediatric surgical patient who received general anesthesia for Salter innominate osteotomy and had generalized convulsions following 5% dextrose administration. Sodium concentration at immediate postconvulsive period revealed 122 mEq/L, appropriate fluid & electrolyte therapy was performed, then sodium level was successfully restored without any sequelae found. We emphasize that it should be checked out prudently whether postoperative free water is administered in the case of postoperative convulsion, while surgical stimuli and anesthesia itself elevate serum antidiuretic hormone level.
Anesthesia ; Anesthesia, General ; Female ; Glucose ; Humans ; Hyponatremia ; Neurologic Manifestations ; Osteotomy ; Postoperative Complications ; Seizures* ; Sodium ; Water ; Water Intoxication

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

ConstaVac (Stryker, Michigan, U.S.A.), a blood drainage and transfusion device, was applied to transfuse the autologous blood from the wound in 20 patients undergoing total replacement under the spinal anesthesia To evaluate the hemodynamic states, direct arterial blood pressures and central venaus pressures were monitored. Before touniquets release, 500-1000 ml of 10% pentastarch were infused rapidly to prevent hypovolemia until the driining reservior bag was filled to at least 40 ml. During all the procedures the mean arterial pressures were main-tained at about 80 mmHg, even if tbose after the induction of anesthesia were lower tban those at the preanesthetic period. The average amounts of blood loss were 942 ml and 2240 ml in unilateral and simultaneous bilateral surgery, respectively. The average amounts of blood that were salvaged after unilateral and simultaneous bilateral knee arthroplasty were 1113 and 2918 ml, respectively. Until 7 posto-perative days, thrombocytopenia and anemia were developed in one and three cases, respectively. We concluded that the use of the ConstaVac in the immediate postoperative period is a useful and practical method of autologous transfusion and conservation of a previous resource, and we recommend its use especially in simultaneous bilateral knee arthroplasty.
Anemia ; Anesthesia ; Anesthesia, Spinal ; Arterial Pressure ; Arthroplasty ; Arthroplasty, Replacement, Knee* ; Blood Transfusion, Autologous* ; Drainage* ; Hemodynamics ; Humans ; Hydroxyethyl Starch Derivatives ; Hypovolemia ; Knee ; Michigan ; Postoperative Period ; Thrombocytopenia ; Wounds and Injuries

The effects of adding 50 ug fentanyl or 3 mg morphine to 0,5% bupivacaine for the epidural anesthesia in cesrean section were evaluated. The 59 women for elective cesarean section were randomly allocated into 3 groups. The first group (n=15) was administered epidurally with 0,5% bupivacaine alone, the second group (n=18), 0.5% bupivacaine mixed with 50 ug fentanyl, and the third group (n=l6), 0.5% bupivacaine mixed with 3 mg morphine. No significant differences among the groups were noted in systolic and diastolic blood pressure, heart rate, respiratiory rate, and tidal volume. There were no significant differences among the groups in the incidence of adverse effects (nausea, vomiting, dizziness, hypotension, pruritus, urinary retention, respiratory depression) in the perianesthetic period and in the onset time of anesthesia up to T4 sensory dermatome. Durations of the anesthesia and postoperative analgesia are prolonged significantly in the second and third groups compared with the first. We found no differences in the neonatal outcome among the groups. Therefore, we conclude that the addition of 50 ug fentanyl or 3 mg morphine to 0.5% bupivacaine during epidural anesthesia for the cesarean section significantly prolongs the duration of anesthesia and postoperative analgesia with no deleterious effects on neonatal or maternal outcome.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Blood Pressure ; Bupivacaine* ; Cesarean Section* ; Dizziness ; Female ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Incidence ; Morphine* ; Pregnancy ; Pruritus ; Tidal Volume ; Urinary Retention ; Vomiting

One-lung anesthesia can be very helpful to the surgeon during operations on the lung, mediastinum, esophagus, and thoracic aorta The standard method for one-lung anesthesia uses a double-lumen tube (Carlens, Robertshaw, etc). However, these tubes are diffieult to place and may not remain in a correct position. In addition, the lumen of each channel is inevitably too smaU for proper ventilation and suctioning. We have designed a new device for one-lung anesthesia which overcomes these disadvantages. This new device, named SLT (single-lumen tube), was made by amoured wire tube, the proximal end of which was connected to the Rusch rubber tube. So, this tube is larger in diameter, available in various sizes and very economic. We intubated 25 cardiothoracic patients with SLT under the fiberoptic guidance (Group A), and the other 25 cardiothoracic patients were intubated with Bobertshaw double-lumen tube by the direct laryngoscopy (Group B). There were no significant differences in heart rate, blood pressure, PH, PaCO2, PaO2 BE, HCO3, SaO2 and ETCO2 between the two groups compared with induction, one-lung ventilation, and two-lung ventilation values.
Anesthesia ; Aorta, Thoracic ; Blood Gas Analysis* ; Blood Pressure ; Esophagus ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Laryngoscopy ; Lung ; Mediastinum ; One-Lung Ventilation* ; Rubber ; Suction ; Ventilation

The effect of the proteinase-inhibitor aprotinin on blood loss and homologous blood requirement in repeat mitral valve replacement whieh has a tendency of postoperative bleeding and increases requirement of homologous blood transfusion was investigated. In a prospective study, 15 adult patients were treated with high-dose aprotinin (according to body weight) who were assigned to aprotinin group while 12 patients without aprotinin administration served as the controls. The average blood loss 24 hours postoperatively in the aprotinin group was 357.3+/-44.0 mL compared with 1606.7+/-214.2 mL in the control group (P<0.05). Total homologous blood requirements were also significantly less in the aprotinin group (0.93+/-0.4 units), compared with the control group (5.42+/-0.6 units) (P<0.05). All patients in the control group and 47% in the aprotinin group received homologous blood transfusion. This study shows the efficacy of high-dose aprotinin therapy in reducing posto-perative blood loss and homologous blood requirement in the complicated repeat cardiac surgery. In addition reduction of intraoperative blood loss may lead to reduction of operative length. Therefore, the routine use of aprotinin can be recommended for the patients undergoing repeat cardiac surgery.
Adult ; Aprotinin* ; Blood Transfusion* ; Heart* ; Hemorrhage ; Humans ; Mitral Valve ; Prospective Studies ; Thoracic Surgery*

There are several situations where the indications for changing an endotracheal tube is absolute and relative in ICU. Intubation times of 7 days or less have a low but significant incidence of serious sequelae in the modern ICU settings. In general, three techniques (Direct laryngoscopy, Tube exchangers, Fiberoptic bronchoscopy) are available for changing endotracheal tube. Each techniques is examined in terms of its advantages and disadvantages, along with its potential complication. The majority of anesthesiologists are familiar with direct laryngoscopy, however, the technique has some serious potential disadvantages. Direct laryngoscopy involves a significant stress on the cardiovascular system. Either this stress or the sedation that may be given to blunt it may be deleterious in a marginal patients. Use of tube exchangers have become popular because of their relative simplicity, widespread availability, and their potential for providing oxygenation, minimal need for sedatives and little hemodynamic insult, atraumatic teehniques. Ineluded in the study were 43 patients scheduled for changing of endotracheal tube admitted at ICU. The purpose of the present study is to compare with time, pulse rate, SaO2 between direct laryngoscopy and tube exchangers so as to endotracheal reintubation. The results were as follows. 1) Use of 19F sized tube exchanger, 21 cases were succeeded among 21 cases, but 3 cases were succeeded among 8 cases using 11F sized tube exchangers. 2) In the tube exchanger group, 28 cases among 29 cases were succeeded without use of sedatives or muscle relaxant. In laryngoscopy group, 10 cases among 14 cases were succeeded use of sedatives, 4 cases among 14 cases were succeeded use of muscle relaxants. 3) SaO2 was significantly lower in direct laryngoscopy group than tube exchanger group after tube exchange.
Cardiovascular System ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Incidence ; Intubation ; Laryngoscopy ; Oxygen*

Suceinylcholine(SCC)-induced hyperkalemia due to mechanical neuromuscular defects sueh as burn, severe trauma, uremia, neuromuscular diseases and etc. is well recognized from 1950. The upper motor neuron diseases are categorized into these neuromuscular diseases. For cerebral palsy, one of the upper motor neuron diseases, there are many different opinions in hyperkalemia after the administration of SCC. To establish the effects of SCC on hyperkalemia, in children with cerebral palsy presenting for selective posterior rhizotomy under the monitoring of evoked EMG, serum potassium, sodium, calcium, chloride and creatine phosphokinase (CPK) were measured prior to, and 2, 5, 10 and 30 min after the administration of SCC. The results are as follows,; 1) The mean age and body weight in twenty patients were 4.4+/-1.4 years and 14.2+/-2.1 kg, respectively. 2) Fine fasciculation on the hand, 1 graded by Cullen, occurred only in five of twenty patients. 3) There is no significant increase in the concentrations of potassium (ranges of mean ; 4.16- 4.23 mEq/L) and CPK (ranges 2.43-295 mEq/L) with the administration of SCC until 30 min. . 4) No significant changes in sodium, calcium and chloride following SCC are revealed. In conclusion,succinylcholine does not produce an increase in plasma potassium in children with cerebral palsy. However, CPK levels trend to increase after the administration, even if there is no statistically significant difference in the levels at the different time sequences.
Body Weight ; Burns ; Calcium ; Cerebral Palsy* ; Child ; Creatine Kinase ; Fasciculation ; Hand ; Humans ; Hyperkalemia ; Motor Neuron Disease ; Neuromuscular Diseases ; Plasma ; Potassium ; Rhizotomy ; Sodium ; Succinylcholine* ; Uremia

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