A number of drug administered during anesthesia can provoke pathologic response by immunologic or nonimmunologic mechanisms. Known drugs involved in hypersensitivity reactions are muscle relaxants, local anesthetics, narcotics, barbiturates, contrast media, protamine and antibiotics. Clinical manifestations of anaphylaxis are diverse, but during anesthesia, cardiovascular collapse is predominate. We experienced a case of anaphylactoid reaction with erythema on upper thoracic region, severe hypotension, tachycardia and ventricular fibrillation. After defibrillation, the patient was recovered. During follow-up, we knew that this patient was exposed aprotinin repeatedly, and suspect the possibility of anaphylactoid reaction due to aprotinin.
Anaphylaxis ; Anesthesia ; Anesthetics, Local ; Anti-Bacterial Agents ; Aprotinin ; Barbiturates ; Contrast Media ; Erythema ; Follow-Up Studies ; Heart Arrest* ; Humans ; Hypersensitivity ; Hypotension ; Narcotics ; Tachycardia ; Ventricular Fibrillation

BACKGROUND: Since the initial report on anesthesia for the renal transplantation from Peter Bent Brighan Hospital in 1962, the anesthesia for kidney transplantation has been reviewed and discussed by many authors. We have performed 200 renal transplantations from August 1990 to October 1996. No cadaveric donor was used and all except two cases was the first graft. METHODS: Anesthetic procedures in the recipients were as follows; 1) The recipient was dialysed within 24 hrs prior to operation. 2) Premedication was done as glycopyrrolate and fentanyl, or glycopyrrolate and diazepam. 3) Thiopental and vecuronium, or thiopental and succinylcholine were used for anesthetic induction. 4) N2O-O2-relaxant (vecuronium) with halothane or isoflurane were used for maintenance. 5) Neostigmine or pyridostigmine were also used to antagonize against the relaxant. 6) CVP was maintained around 10~17 cmH2O. RESULTS: The results were as follows; 1) The mean ages of donors and recipients were 35.3 and 37.4, respectively. The ratio of male to female of donors and recipients was 1.6 : 1 and 1.6 : 1, respectively. 2) One hundred and ten cases (55.0%) were living unrelated donors and 90 cases (45.0%) were living related donors. 3) Overall graft and patient survival rate was 96.9 and 98.0 at 1 year, 94.1 and 95.1 at 3 years. CONCLUSIONS: Most patients with renal failure have several common problems that are of significance to anesthesiologists, including anemia, bleeding tendency, electrolyte imbalance, acidosis, hypertension, hyper- or hypovolemia, and previous therapy with steroids and immunosuppressants, etc. Therefore anesthesiologists should keep in mind the risk factors above mentioned for the anesthetic management of patients with renal failure.
Acidosis ; Anemia ; Anesthesia ; Cadaver ; Diazepam ; Female ; Fentanyl ; Glycopyrrolate ; Halothane ; Hemorrhage ; Humans ; Hypertension ; Hypovolemia ; Immunosuppressive Agents ; Isoflurane ; Kidney Transplantation* ; Male ; Neostigmine ; Premedication ; Pyridostigmine Bromide ; Renal Insufficiency ; Risk Factors ; Steroids ; Succinylcholine ; Survival Rate ; Thiopental ; Tissue Donors ; Transplants ; Unrelated Donors ; Vecuronium Bromide

Reexpansion pulmonary edema(RPE) is a complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion or atelectasis, and generally believed to occur ipsilaterally when a chronically collapsed lung is rapidly reexpanded by evacuation of large amount of air or fluid. Clinical manifestations of RPE are dyspnea, tachypnea, cyanosis, frothy blood-tinged sputum, wet rale, and expiratory wheezing. Hypotension and decrease in organ perfusion can occur. We experienced intraoperative tension pneumothorax probably due to positive pressure ventilation or pleural injury during central venous catheterization through internal jugular vein. And bilateral RPE combined with acute renal failure occurs after spontaneous decompression of tension pneumothorax with chest tube insertion, even with brief duration of lung collapse.
Acute Kidney Injury ; Catheterization, Central Venous ; Central Venous Catheters ; Chest Tubes ; Cyanosis ; Decompression* ; Dyspnea ; Edema ; Hypotension ; Jugular Veins ; Lung ; Perfusion ; Pleural Effusion ; Pneumothorax* ; Positive-Pressure Respiration ; Pulmonary Atelectasis ; Pulmonary Edema* ; Respiratory Sounds ; Sputum ; Tachypnea

Myasthenia Gravis is a neuromuscular disorder manifested by increasing weakness and fatigability of voluntary muscles with exercise, and partial or complete restoration of function following rest or the administration of anticholinesterase drugs. The anesthesiologists may be called upon to assist in the diagnosis of myasthenis, in treating the patient by artificial ventilation during acute exacerbations, to anesthetise the patient for thymectomy or other surgery. Therefore, the anesthesiologists must be familiar with the diagnosis and treatment of myasthnia gravis to carry on the appropriate therapy. Two cases of anesthesia for thymectomy in myasthenia gravis without using muscle relaxants was experienced, and no respiratory problems were encountered postoperatively.
Anesthesia* ; Cholinesterase Inhibitors ; Diagnosis ; Humans ; Muscle, Skeletal ; Myasthenia Gravis* ; Thymectomy* ; Ventilation

Numerous devices and techniques have been devised to facillitate the difficult endotracheal intubation. Percutaneous retrograde intubation was first described by Waters, who used a Tuohy needle to puncture the cricothyroid membrane and an epidural catheter as a guideline in 1963 and many variations on the technique have been described. Failure to intubate 2 male adult patients were planned retrograde tracheal intubation using the cricothyroid membrane. While the patients were awake, and after adequate local anesthesia was obtained, a 16G Medicut was punctured through cricothyroid membrane. After confirmation of the intratracheal position by aspiration of air into syringe, the opening of the Medicut was directed upward foward the larynx and the epidural catheter was inserted through it and advanced retrograde between the vocal cords and into mouth. The epidural catheter tip was passed through the Murphy's eye from outside to inside and out of the tracheal tube. By keeping the catheter taut and coincidently pulling back, the tube was advanced into trachea. Correct positioning of the tracheal tube inside the trachea was confirmed by end-tidal carbon dioxide monitoring and auscultation. Another 2 male adult patients were intubated by using cricotracheal retrograde approach method. We experienced successful retrograde tracheal intubation without significant complications using an epidural catheter through cricothyroid membrane and cricotracheal ligament in 4 male adult patients who were predicted impossibility of simple orotracheal intubation. (Korean J Anesthesiol 1995; 29: 304~309)
Adult ; Anesthesia, Local ; Auscultation ; Carbon Dioxide ; Catheters ; Humans ; Intubation* ; Intubation, Intratracheal ; Larynx ; Ligaments* ; Male ; Membranes* ; Mouth ; Needles ; Punctures ; Syringes ; Trachea ; Vocal Cords

No abstract available.
Transplants

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO2). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO2 and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO2 insufflation (control value), 15 minute after CO2 insufflation, after gall bladder delivery out, 15 minute after CO2 excretion. After CO2 insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO2 were increased sigmficantly in comparison to control values (P-value<0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO2) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO2) was not changed significantly. After CO2 excretion, systolic and diastolic pressure, end-tidal CO2 were increased in comparison to control values (P<0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO2 were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO2 insufflation according to continuous monitoring of end-tidal CO2 and arterial carbon dioxide tension.
Absorption ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Insufflation ; Laparoscopy ; Oxygen ; Pulmonary Gas Exchange* ; Urinary Bladder ; Ventilation ; Vital Signs*

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO2). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO2 and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO2 insufflation (control value), 15 minute after CO2 insufflation, after gall bladder delivery out, 15 minute after CO2 excretion. After CO2 insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO2 were increased sigmficantly in comparison to control values (P-value<0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO2) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO2) was not changed significantly. After CO2 excretion, systolic and diastolic pressure, end-tidal CO2 were increased in comparison to control values (P<0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO2 were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO2 insufflation according to continuous monitoring of end-tidal CO2 and arterial carbon dioxide tension.
Absorption ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Insufflation ; Laparoscopy ; Oxygen ; Pulmonary Gas Exchange* ; Urinary Bladder ; Ventilation ; Vital Signs*

Pulmonary edema may be defined broadly as excessive fluid accumulation in the interstitial and air spaces of the lung. We recently a previously healthy parturient with ritodrine treatment who suddenly developed severe pulmonary edema during a Cesarian Section under Genera) Anesthesia, For this presented cases, we believe that overloading, Ritodrine, oxytocin, ergot derivatives wi11 be the causative factors. We had good result with PEEP, diuretics, and morphines.
Anesthesia ; Diuretics ; Lung ; Morphine Derivatives ; Oxytocin ; Pulmonary Edema* ; Ritodrine

Cannulation of the internaliugular vein was first described by English et al in l969; since then, it has steadily increased in popularity to its present position as one of the methods of choise for CVP monitorimg. But this method of CVP monitoring has some potential compolication such as infection, thrombophlebitis, pneumothorax, hydrothorax, hematoma, air embolism, catheter shearing, nerve injuries & pericardial tamponade, etc. We experienced a case of hydrothorax following internal jugular vein catheterization.
Cardiac Tamponade ; Catheterization* ; Catheters* ; Embolism, Air ; Hematoma ; Hydrothorax ; Jugular Veins* ; Pneumothorax ; Thrombophlebitis ; Veins