BACKGROUND: It is a routine practice that High Frequency Jet Ventilation (HFJV) is applied through a 14~16 gauge (about 12 French (Fr.)) angiocath. The 14 Fr. suction catheter which is similar to angiocath in its internal diameter is commonly available in the operating room. We evaluated the suction catheter as a carrier of HFJV in point of ventilation, oxygenation and operating field during HFJV at microlaryngeal endoscopic surgery (MES). METHODS: Fifteen adult patients undergoing HFJV via 14 Fr. suction catheter during MES were studied. Time-based arterial blood gas analyses were done before and after HFJV. The movement of operating field was examined using laryngoscopic examination by surgeon and anesthesiologist. We also evaluated complications such as abdominal distension, barotrauma and so on. RESULTS: The mean arterial oxygen tension was maintained above 250 mmHg all the time during HFJV. The mean carbon dioxide tension was less than 51 mmHg. There were no remarkable catheter movement and complications. CONCLUSION: The 14 Fr. suction catheter is a good replacement of angiocath. It provided good operating field, ventilation and oxygenation without complications.
Adult ; Barotrauma ; Blood Gas Analysis ; Carbon Dioxide ; Catheters* ; High-Frequency Jet Ventilation* ; Humans ; Operating Rooms ; Oxygen ; Suction* ; Ventilation

BACKGROUND: Beat-to-beat heart rate variability (HRV) is caused by the fluctuating balance of sympathetic and parasympathetic tone. Analysis of heart rate variations may provide important clinical information and the influence of anesthesia on the autonomic nervous system. METHODS: We studied 18 ASA I female patients undergoing propofol-O2-N2O anesthesia for transabdominal hysterectomy and analyzed the HRV using power spectral analysis (PSA) at preinduction period, 2~5 minutes after induction, and 30~33 minutes after skin incision. RESULTS: The powers in all frequency bands decreased, but the decrease in low+middle frequency power was less than that in high frequency power during 2~5 minutes after induction. At 30~33 minutes after skin incision, all frequency bands and ratio of low middle/high frequency power spectra recovered and were not significantly different from those of before induction. CONCLUSIONS: Propofol-N2O-O2 anesthesia depress autonomic nervous system with relative preservation of sympathetic components. However autonomic nervous system and sympathetic/parasympathetic balance during operation recovered to the pre-anesthetic pattern, probably due to surgical stimuli and stress.
Anesthesia* ; Anesthetics ; Autonomic Nervous System ; Female ; Heart Rate* ; Heart* ; Humans ; Hysterectomy ; Skin

Many factors influence the distribution of local anesthetic solutions within the subarachnoid space. Among the factors which are under the control of the anesthesiologists, the effect of direction of bevel on spinal anesthetic spread was investigated in 40 young adult male patients undergoing orthopedic or urologic surgery, with ASA physical status 1. Patients were randomized into one of four groups, according to the direction of bevel(cephalad, caudad, up, down). With patient in the lateral decubitus position, dural puncture was performed in the midline at the L3-4 interspace with a 23-gauge needle, and the patients were immediately turned to supine position. Local anesthetic solution in all patients was composed of 1.6 ml of 1% tetracaine and 1.6 ml of 10% dextrose, resulting 3.2 ml(16 mg) of 0.5% tetracaine. Segmental spread of analgesia was determined by pin-prick in the anterior axillary line. Duration of block and degree of motor block were measured by two segment regression time and Bromage scale, respectively. No difference was observed among four groups in the onset time to maximal level of sensory block, two segment regression time, and degree of complete motor block of lower limbs. In caudal group, maximal level of sensory block was about 1.1-1.4 segments lower than other groups, but no statistical significance was found. There were wide variations in the maximal level of sensory block(T11-T3), and time to reach this(5 min-35 min). The present study indicates that the direction of bevel is unimportant in influencing anesthetic characteristics of spinal anesthesia and, it is difficult to predict accurately the onset time and the level which will be attained because there are wide individual variations in the spread of local anesthetics in subarachnoid spaee.
Analgesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Glucose ; Humans ; Lower Extremity ; Male ; Needles ; Orthopedics ; Punctures ; Subarachnoid Space ; Supine Position ; Tetracaine* ; Young Adult

BACKGROUND: In spite of adverse reactions, morphine has been used as a basic constituent for patient controlled analgesia (PCA). Because morphine affects various immune functions, PCA with morphine may deteriorate immune mechanisms further after surgery. In this study we decided to determine how different is the morphine PCA from the combination of morphine and ketorolac in Interleukin-6 (IL-6) and IL-10 responses, analgesia and side effects. METHODS: Twenty two patients undergoing abdominal hysterectomy were randomly divided to two groups: PCA with morphine and PCA with the combination of morphine and ketorolac. Blood samples to measure cytokines were collected before induction of anesthesia, immediately after surgery, 1, 4, 24 h after PCA. Plasma was separated and frozen until the analysis of cytokines with ELISA. Postoperative pain was assessed using a visual analog score (VAS). Sedation was checked according to our protocol. RESULTS: In both groups IL-6 response rose immediately after surgery and stayed increased until 24 h, and IL-10 level peaked at 1 h after PCA then progressively declined. In the comparison of cytokines between the two groups there were significant differences in IL-6 at 24 h (P=0.026) and IL-10 at 4 h after PCA (P=0.03). In morphine consumption between the two groups there were significant differences (P=0.037 at 4 after PCA, P=0.015 at 24 h after PCA), however, pain scores, sedation and side effects were unaffected by the PCA regimen. CONCLUSIONS: We conclude that the supplementation of ketorolac with morphine modify the cytokine responses and in this way may contribute immune alterations during post-operative period.
Analgesia ; Analgesia, Patient-Controlled ; Anesthesia ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hysterectomy* ; Interleukin-10* ; Interleukin-6* ; Ketorolac* ; Morphine* ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Plasma

BACKGROUND: Shivering is a common postanesthetic complication. Because all shivering patients feel uncomfortable and increase oxygen consumption, various attempts have been made to prevent its occurrence or to control it. Among the pharmacological methods of treating shivering, meperidine has been known to be the most effective. This study was designed to evaluate whether there was any difference among meperidine, fentanyl, doxapram and normal saline in the treatment of post-anesthetic shivering. METHODS: Forty patients (ASA class I or II) who showed postoperative shivering were randomly assigned into four groups (n=10): Normal saline group: normal saline 5 ml, Doxapram group: doxapram 1.5 mg/kg, Meperidine group: meperidine 25 mg, Fentanyl group: fentanyl 25 microgram. And all patients received routine care: oxygen by T-piece and heat-reflective blanketrol (cincinati Subzero, U.S.A.). Evaluation of the state of shivering was done every 5 minutes from the beginning of the treatment by the same investigator who had injected the drugs intravenously for treatment of shivering. The age, sex, weight and duration of surgery were recorded. RESULTS: There were no significant statistical differences in age, sex, weight and duration of surgery among the four groups. By 5 minutes, 90% of doxapram group and 30% of meperidine group had stopped shivering. By 10 minutes, 90% of doxapram group and 70% of meperidine group had stopped shivering. But in fentanyl and normal saline group, only 20% had stoppd shivering by 10 minutes. CONCLUSIONS: We conclude that both meperidine and doxapram are effective on post-anesthetic shivering. In cases of patient with respiratory depression, doxapram is especially effective because it stimulates the respiratory center.
Doxapram* ; Fentanyl* ; Humans ; Meperidine* ; Oxygen ; Oxygen Consumption ; Research Personnel ; Respiratory Center ; Respiratory Insufficiency ; Shivering*

BACKGROUND: Marked derangements in acid-base status are frequently seen during orthotopic liver transplantaton. To prevent the progression of metabolic acidosis, treatment with sodium bicarbonate has been recommended. However, sodium bicarbonate may exacerbate intracellular acidosis, increase plasma lactate, contribute to hypernatremia. The value of giving bicarbonate has been questioned. Accordingly, we reviewed the intraoperative the acid-base status of patients who underwent orthotopic liver transplatation. METHODS: We reviewed ten patients showed severe metabolic acidosis (7.2 < pH < 7.30 and base deficit (BD) > or = 10). Despite of BD > or = 10, sodium bicarbonate was not given to all. Intraoperative pH and BD were analyzed retrospectively. RESULTS: At the anhepatic and immediate post-reperfusion periods, the pH was decreased (P < 0.05) and BD was increased (P < 0.05), but both were normalized at the end of surgery. The mean blood pressure transiently decreased at the immediate post-reperfusion periods (P < 0.05), but that was acceptable. CONCLUSIONS: This study showed that a severe metabolic acidosis is tolerated by the patients undergoing orthotopic liver transplantation without administration of sodium bicarbonate.
Acidosis ; Blood Pressure ; Humans ; Hydrogen-Ion Concentration ; Hypernatremia ; Lactic Acid ; Liver Transplantation* ; Liver* ; Plasma ; Retrospective Studies ; Sodium Bicarbonate* ; Sodium*

BACKGROUND: Marked derangements in acid-base status are frequently seen during orthotopic liver transplantaton. To prevent the progression of metabolic acidosis, treatment with sodium bicarbonate has been recommended. However, sodium bicarbonate may exacerbate intracellular acidosis, increase plasma lactate, contribute to hypernatremia. The value of giving bicarbonate has been questioned. Accordingly, we reviewed the intraoperative the acid-base status of patients who underwent orthotopic liver transplatation. METHODS: We reviewed ten patients showed severe metabolic acidosis (7.2 < pH < 7.30 and base deficit (BD) > or = 10). Despite of BD > or = 10, sodium bicarbonate was not given to all. Intraoperative pH and BD were analyzed retrospectively. RESULTS: At the anhepatic and immediate post-reperfusion periods, the pH was decreased (P < 0.05) and BD was increased (P < 0.05), but both were normalized at the end of surgery. The mean blood pressure transiently decreased at the immediate post-reperfusion periods (P < 0.05), but that was acceptable. CONCLUSIONS: This study showed that a severe metabolic acidosis is tolerated by the patients undergoing orthotopic liver transplantation without administration of sodium bicarbonate.
Acidosis ; Blood Pressure ; Humans ; Hydrogen-Ion Concentration ; Hypernatremia ; Lactic Acid ; Liver Transplantation* ; Liver* ; Plasma ; Retrospective Studies ; Sodium Bicarbonate* ; Sodium*

Cold hemagglutinin disease is a form of immune hemolytic anemia caused by cold-reactive immunoglobulins. Cold agglutinins are autoantibodies, usually of the IgM type, that cause red blood cell agglutination at reduced temperatures. When the agglutinated antibody-covered red blood cells return to the central circulation, the classical complement pathway is activated. Complement components combine with the antibody-covered red blood cells, inducing membrane changes that result in intravascular hemolysis. Clinical manifestations of cold hemagglutinin disease, which occur only on cold exposure include acrocyanosis, purpura, Raynauds phenomenon, acral gangrene, immune complex nephritis, and hemolytic anemia. We experienced a case of 66-year-old woman with cold agglutinin disease, gastric cancer and gall bladder stone. Preoperative plasmapheresis and intraoperative forced air convective warming to minimize red blood cell agglutination and hemolysis were performed. The operating room was prewarmed to 31~32degrees C. The patient had her lower body and the upper extremities covered with warming blankets. Inspired gases were humidified at 37degrees C and intravenous fluids were warmed with a blood warmer. Peripheral body temperature was maintained above 36.5degrees C throughout the procedure. Subtotal gastrectomy and cholecystectomy were done successfully without complication. It can be concluded that the maintenance of central and peripheral body temperature above the thermal aetivity of the cold agglutinin is required during the perioperative period.
Aged ; Agglutination ; Agglutinins ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Anesthesia, General* ; Antigen-Antibody Complex ; Autoantibodies ; Body Temperature ; Cholecystectomy ; Complement Pathway, Classical ; Complement System Proteins ; Erythrocytes ; Female ; Gangrene ; Gases ; Gastrectomy ; Hemagglutinins ; Hemolysis ; Humans ; Immunoglobulin M ; Immunoglobulins ; Membranes ; Nephritis ; Operating Rooms ; Perioperative Period ; Plasmapheresis ; Purpura ; Stomach Neoplasms ; Upper Extremity ; Urinary Bladder Calculi

Because of their location, mediastinal masses often involve vital structures, and can give rise to life-threatening complications during aresthesia. We present a case in which left main bronchial obstruction, compression of right puhronary artery, and probable myocardial involvement caused cardiac arrest on induction of general anesthesia. The patient was a 4-year-old, 14-kg boy complaining with a dry cough and intermittent fever for two months. His chest roentgenogram and computerized tomography showed that a large posterior mediastinal mass compresses the left main bronchus and right main pulmonary artery. Preoperative examination revealed a thin boy with intermittent tachypnea and absence of breath sounds in left anterior chest, but his arterial blood gas analysis was normal. In spite of a well-controlled airway and good ventilation, we were unable to oxygenate the child, and cardiac arrest was followed. All resuscitative measures including external cardiac massage, intravenous and endotracheal epinephrine, bicarbonate, and calcium gluconate were ineffective until his chest was opened to relieve compression of pulmonary artery and heart. This case demonstrates that unexpected cyanosis and cardiac arrest in presence of mediastinal mass may well due to cardiovascular compression especially with compression of pulmonary artery.
Anesthesia* ; Anesthesia, General ; Arteries ; Blood Gas Analysis ; Bronchi ; Calcium Gluconate ; Child* ; Child, Preschool ; Cough ; Cyanosis ; Epinephrine ; Fever ; Heart ; Heart Arrest* ; Heart Massage ; Humans ; Male ; Oxygen ; Pulmonary Artery ; Tachypnea ; Thorax ; Ventilation

Clonic movement is a rare complication that occurs after neuraxial blockade. We report our experience with an 18-year-old man developing myoclonic movement on his both upper extremities following intrathecal injection of 0.5% hyperbaric bupivacaine for varicocelectomy. One and half hour after spinal anesthesia, he developed bilateral, rhythmic myoclonic movements on upper extremities. Two days after surgery, neck flexion was observed. Symptoms sustained for about one month but frequency and severity of clonic movement had been reduced by anticonvulsants and muscle relaxant therapy. Four weeks later, he recovered without any complication.
Adolescent ; Anesthesia, Spinal ; Anticonvulsants ; Bupivacaine ; Humans ; Injections, Spinal ; Muscles ; Myoclonus ; Neck ; Upper Extremity