BACKGROUND: 42 anesthesia-related medico-legal cases, consulted to the Korean Society of Anesthesiologists (KSA) in a recent 2 year period (1994, 11~1996, 10) were analysed. METHOD: Results of the analysis were classified into 11 items. RESULTS: Cases sources were 26 cases from civil court, 2 cases from criminal court, 8 cases from police stations and 6 cases from health centers, and involved surgical departments were obstetric & gynecology (17 cases), general surgery (7), orthopedic surgery (6), and others (12). Operation classification were Cesarean section (14 cases), reduction and fixations (5), gastrectomy (4) and others (19), and anesthesia methods were general anesthesia (36 cases), regional anesthesia (3), and local anesthesia (3). Involved hospitals were university hospitals (15), general hospitals (16) and private clinics (11), and involved anesthesiologists (anesthetists) were certified anesthesiologists (34), nurse anesthetists (3), and others (5). Patient's ages were classified into 0~20 years old (4), 20~40 years old (23), 40~60 years old (13) and over 60 years old (2), and patient's sex ratio was 16 (male) to 26 (female). Outcome of victims were deaths (26 cases), severe brain damages (10) and nerve injuries (6), and autopsy findings were hypoxic brain edema (4 cases), coronary artery diseases (3), and other findings (4). Causes of medico-legal problems were hypoxemia by ventilatory failure (12), pre-existing diseases (4), embolisms followed by operation (2), malignant hyperthermia (1), and uncertain cases (21). CONCLUSION: The most common cause of medico-legal problems was hypoxemia by ventilatory failure.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Local ; Anoxia ; Autopsy ; Brain ; Brain Edema ; Cesarean Section ; Classification ; Coronary Artery Disease ; Criminals ; Embolism ; Female ; Gastrectomy ; Gynecology ; Hospitals, General ; Hospitals, University ; Humans ; Malignant Hyperthermia ; Middle Aged ; Nurse Anesthetists ; Orthopedics ; Police ; Preexisting Condition Coverage ; Pregnancy ; Sex Ratio

Background: Univent(R) tube was designed to overcome the disadvantages of double lumen endotracheal tube for one lung anesthesia. But overinflation of the blocker cuff of an endobronchial tube can cause pressure damage to the bronchus. The purpose of this study was to evaluate whether the blocker cuff pressure and the duration of ballooning using the Univent(R) tube is correlated with the degree of bronchial mucosal damage (BMD). Methods: A total of 13 men and 7 women intubated with the Univent(R) tube were enrolled for the study. The BMD were evaluated by direct visualization using fiberoptic bronchoscopy prior to intubation and following extubation and the degree of the BMD were scored from 0 to 4 as follows; 0: normal, 1: erythema, 2: swelling, 3: hemorrhage, 4: mucosal wall tearing. Results: No change in bronchial mucosa (score 0) were observed in 11 patients (55%), erythema (score 1) in 5 patients (25%), swelling (score 2) in 3 patients (15%), hemorrhage (score 3) in 1 patient (5%) and mucosal wall tearing (score 4) is none in 20 patients. The bronchial blocker cuff pressure required to "just sealing" the bronchus was 178.1+/-37.4 mmHg with corresponding cuff volume of 6.7+/-1.0 cc. The duration of ballooning was 115.5+/-26.4 min. The correlation coefficient between the blocker cuff pressure and duration of ballooning to the degree of bronchial mucosal damage were 0.125 and 0.137, respectively, which was not statistically significant. Conclusions: The bronchial blocker of Univent(R) tube doesn't cause any severe BMD and the degree of BMD are correlated with neither the bronchial blocker cuff pressure nor duration of ballooning of Univent(R) tube.
Anesthesia ; Bronchi ; Bronchoscopy ; Erythema ; Female ; Hemorrhage ; Humans ; Intubation ; Lung ; Male ; Mucous Membrane

No abstract available.

Adult polycystic kidney disease is a genetic disease characterized by bilateral multiple renal cysts and is transmitted as an autosomal dominant traits. The disease usually manifests in the fourth decade of life. The affected patients usually die with end stage renal failure, cardiovascular assaults and infection etc. Cardiovascular assaults include ruptured berry aneurysm, spontaneous intracranial hemorrhage, acute myocardial infarction, dissecting aortic aneurysm and hypertensive heart failure. Fatal intracranial hemorrhage and hypertensive heart failure occur in 15% and 2% of patients, respectively. Genetically-determined structural weakness in the arterial wall have been suggested as a possible factor in the genesis of berry aneurysm. We have experienced three autopsy cases with cardiovascular causes of sudden death. Two cases have intracranial hemorrhage (1 berry aneurysm and 1 intracerebral hemorrhage) and the remaining one is dead with hypertensive cardiomyopathy. All of them are aged over 40 years and associated with polycystic liver disease. Histologically, myriad cysts of enlarged bilateral kidney are lined by single layer of cuboidal cells with focal hyperplastic epithelial configuration. Diffusely scattered liver cysts are also lined by flat to cuboidal epithelium and often associated with portal fibrosis.
Adult* ; Aortic Aneurysm ; Autopsy ; Cardiomyopathies ; Cerebral Hemorrhage ; Death, Sudden ; Epithelium ; Fibrosis ; Heart Failure ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Kidney ; Liver ; Liver Diseases ; Myocardial Infarction ; Polycystic Kidney, Autosomal Dominant* ; Renal Insufficiency

Intravenous administration of high dose of fentanyl is gaining wide popularity as the sole anesthetic agent for patients undergoing cardiac surgery because of its favorable characteristics such as, simplicity, stable hemodynamics and supression or modification of stress response to surgery. But some investigators reported the necessity of supplementary anesthetic agent in addition to fentanyl to maintain hemodynamic stability during the surgical procedure. Therefore, we measured the heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and rate pressure product(RPP) at induction, tracheal intubation, skin incision, and sternotomy time to evaluate the cardiovascular responses to surgical procedure under fentanyl-O2 anesthesia on 12 patients with acquired valvular heart disease. The patients were anesthetized with a loading dose (30ug/kg fentanyl for induction and 1.5ug/ kg/min until sternotomy) followed by continuous infusion of fentanyl (0.3pg/kg/min until the end of cardiopulmonary bypass.) The patients required total doses of 108+/-4.6ug/kg fentanyl for the entire operation. These measurements were compared with control data (before induction). The results were as followings: 1) During induction (infusion of fentanyl 30ug/kg), HR, SBF, DBP, MAP, and RPP revealed no significant change compared with control data. 2) During intubation and skin incision, HR, SBP, DBP, MAP, and RPP slightly increased but were not statistically significant (p>0.05) 3) During sternotomy, SBP increased from 119.8+/-16.36 torr to 136.5+/-15.22 torr, DBP increased from 79.1+/-12.76 torr to 95.4+/-10.87 torr, MAP increased from 99.4+/-13.96 torr to 115.5+/-12.70 torr, and RPP increased from 10929+/-2206 torr.beats/min to 13889+/-2865 torr. beats/min (p<0.05). HR increased from 90.7+/-8.71 beats/min to 100.2+/-13.79 beats/min, but was not statistically significant(p> 0.05). 4) One of the patients had recall of the sternotomy and spreading of the chest with the sternal retractor. These data demonstrate that anesthetic doses of fentanyl and O produce minimal change in cardiovascular dynamics during the surgical procedures except sternotomy time. Our findings suggest that fentanyl-O2 anesthesia may be an attractive anesthetic technique in patients with valvular heart disease undergoing valve replacement operations but, will be needed considerations about infusion method, dosage of fentanyl and use of supplementary anesthetic agent according to patients conditions.
Administration, Intravenous ; Anesthesia* ; Anesthetics ; Fentanyl* ; Heart ; Heart Valve Diseases ; Hemodynamics ; Humans ; Intubation ; Methods ; Research Personnel ; Skin ; Sternotomy ; Thoracic Surgery ; Thorax

BACKGROUND: 137 anesthesia-related adverse outcome cases were registered by civil courts, criminal courts, police departments, and district health care centers with the Korean Society of Anesthesiologists between November 1994 and October 2002. These cases were analyzed according to type of event causing the adverse outcomes (death, brain damage, disability). METHODS: 137 adverse outcome cases were classified into obstetric and gynecologic, orthopedic, surgical, and other cases. Also, based upon a review of medical records, anesthesia records, autopsy findings, investigation records and the decisions of civil courts and criminal courts, the cases were classified into four categories; e.g. problems due to anesthetic management, preexisting diseases or preoperative patient conditions, anesthetic agents or anesthetic techniques, and operating procedures. RESULTS: 1) 45 cases were associated with problems due to anesthetic management (ventilatory failure, drug overdose, etc). 2) 39 cases were associated with problem due to preexisting diseases (cardiovascular disease, cerebrovascular disease, diabetes mellitus, etc) or preoperative patient conditions. 3) 27 cases were associated with problems due to anesthetic agents or techniques (nerve injury, malignant hyperthermia, etc). 4) 26 cases were associated with problems due to operating procedures (massive bleeding, embolism, etc). CONCLUSIONS: The most common type of damaging event causing an anesthesia-related adverse outcome was connected with anesthetic management. Therefore, it is mandatory to prepare adequate anesthetic monitoring equipment and to monitor patients thoroughly, to ensure safer perioperative anesthetic management.
Anesthesia ; Anesthetics ; Autopsy ; Brain ; Criminals ; Delivery of Health Care ; Diabetes Mellitus ; Drug Overdose ; Embolism ; Hemorrhage ; Humans ; Korea* ; Malignant Hyperthermia ; Medical Records ; Orthopedics ; Police ; Preexisting Condition Coverage

The effect of induced hypotension with sodium nitroprusside(SNP) on alveolar-arterial oxygen tension difference and pulmonary shunting in 10 surgical patients with normal pulmonary function was studied under general anesthesia. Heart rate, mean arterial pressure, central venous pressure, blood gases and hemoglobin were measured before, during and after SNP infusion. Using the above data, alveolar-arterial oxygen tension difference and pulmonary shunting were calculated. The results were as follows. 1) Mean arterial pressure decreased significantly from 98+/-9.1mmHg before SNP infusion to 61+/-3.0 mmHg during SNP infusion(p<0.001), and increased to 96+/-6.7mmHg again after SNP infusion. 2) Heart rate increased significantly from 78+/-10.5 beats/min. to 101+/-11.9 beats/min.(p<0.001), and decreased to 84+/-11.5 beats/min. again. 3) Arterial oxygen tension decreased from 489+/-32.5mmHg to 480+/-25.0mmHg, but was not statistically significant. (p>0.05). 4) Alveolar-arterial oxygen tension difference increased from 188+/-29.0mmHg to 196+/-25.0mmHg, but was not statistically significant(p>0.05). 5) Pulmonary shunting increased from 9.0+/-1.83% to 9.2+/-1.50%, but was not statistically significant.(p>0.05). The above findings suggest that pulmonary shunting in patients with normal lung function will not affected during induced hypotension with SNP.
Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Gases ; Heart Rate ; Humans ; Hypotension* ; Lung ; Nitroprusside* ; Oxygen* ; Sodium*

Wolff-Parkinson-White (WPW) syndrome is characterized by classical electrocardiographic findings resulting from preexcitation of a part of the ventricular myocardium due to anomalous atrioventricular conduction via a accessory pathway. Anesthetic management with this syndrome is aimed at avoiding tachycardia and cardiac arrhythmia by using the techniques to avoid hypoxia, hypercarbia, acidosis and sympathetic stimulation. We experienced a case of severe hypotension and paroxysmal supraventricular tachycardia (PSVT) during insertion of subclavian vein catheter on a patient with this syndrome prior to operation, in spite of adequate anesthetic management. The patient's condition was recovered after infusion of adenosine and removal of catheter. Operation was postponed for further evaluation of WPW syndrome. After 3 days, electrophysiologic study was done and accessory pathway was ablated by radiofrequency catheter. After 6 days, the patient was operated uneventfully and discharged 2 weeks later. We report that minor stimulation such as central venous catheterization on a patient with WPW syndrome can cause life-threatening severe hypotension and PSVT.
Acidosis ; Adenosine ; Anoxia ; Arrhythmias, Cardiac ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Electrocardiography ; Humans ; Hypotension* ; Myocardium ; Subclavian Vein ; Tachycardia ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome*

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ketamine pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n=30), lidocaine group (n=30) and ketamine group (n=30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, 0.5% ketamine) via 18G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assessment of pain was made at the induction of anesthesia and in the recovery room, and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the ketamine group compared with the saline group at the induction of anesthesia (p<0.05) and there was no significant difference between the lidocaine group and the ketamine group. We had similar results in the recovery room and one patient from the saline group and the ketamine group had no recall regarding injection pain. CONCLUSION: Intravenous ketamine pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.
Anesthesia ; Anesthesia, General ; Arm ; Female ; Humans ; Incidence ; Injections, Intravenous ; Ketamine* ; Lidocaine* ; Propofol* ; Recovery Room ; Tourniquets

Venous air embolism (VAE) can be a lethal complication of surgical procedures during which (1) venous pressure at the site of surgery is subatmospheric or (2) air (or gas) is forced under pressure into a body cavity. We experienced a case of fatal massive venous air embolism during lung surgery in a 52 years old patient undergoing a right upper lobectomy and right lower lobe superior segment wedge resection for lung cancer. Anesthetic induction and the initial intraoperative course were completely uneventful until sudden severe hypotension and abrupt bradycardia occurred after artificial air insufflation into the intraabdominal cavity through the diaphragm to reduce the dead space of the thoracic cavity. We considered a venous air embolism as the etiology of these events and treated the patient with manual cardiac massage, various cardiotonic drugs and removal of air through the right atrium. The patient was extubated at 3 days after surgery and discharged from the hospital without the complication of the venous air embolism.
Bradycardia ; Cardiotonic Agents ; Diaphragm ; Embolism, Air* ; Heart Atria ; Heart Massage ; Humans ; Hypotension ; Insufflation ; Lung Neoplasms ; Lung* ; Middle Aged ; Thoracic Cavity ; Venous Pressure