1.Severe Hyperkalemia without Typical Electrocardiographic Manifestations: A case report.
The Korean Journal of Critical Care Medicine 1999;14(1):42-46
Severe hyperkalemia can induce life threatening cardiac rhythm disturbances, and usually produce classic electrocardiographic (EKG) manifestations. We report a case of severe hyperkalemia in which the EKG did not reveal the expected alterations. The patient was a 57-year-old man with adenocarcinoma of stomach. There were no significant abnormal findings in laboratory analysis, chest X-ray and EKG. His preoperative medications for hypertension consisted of furosemide, amiloride and enalapril. The tests for serum potassium concentration ([K ]) were performed on 20 and 7 days before the operation and the results were 4.5 and 4.9 mEq/l, respectively. Just after induction of anesthesia, we tried the blood gas and electrolyte analysis and the result revealed high [K ] of 8.5 mEq/l, but EKG did not show typical phenotype of hyperkalemia at that time. His intraoperative and postoperative courses were not eventful.
Adenocarcinoma
;
Amiloride
;
Anesthesia
;
Electrocardiography*
;
Enalapril
;
Furosemide
;
Humans
;
Hyperkalemia*
;
Hypertension
;
Ions
;
Middle Aged
;
Phenotype
;
Potassium
;
Stomach
;
Thorax
2.Sedation with Continuous Infusion of Midazolam for Ventilated Patient in Intensive Care Unit.
Shin Ok KOH ; Sang Beom NAM ; Eun Chi BANG
Korean Journal of Anesthesiology 1996;30(5):561-565
BACKGROUND: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring. METHODS: We started continuous infusion of midazolam at a rate of 0.5~1.0 ug/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion. RESULTS: The mean loading dose, infusion rate and total dose of midazolam were 4.1+/-0.9 mg, 1.2+/-0.4 ug/kg/minute and 251.9+/-84.0 mg. The mean duration of infusion was 59.0+/-37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion. CONCLUSIONS: Continuous infusion of midazolam at a rate of 1.2+/-0.4 ug/kg/minute after 4.1+/-0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.
Benzodiazepines
;
Blood Pressure
;
Central Venous Pressure
;
Gases
;
Heart Rate
;
Hemodynamics
;
Humans
;
Hypnotics and Sedatives
;
Intensive Care Units*
;
Critical Care*
;
Kidney
;
Liver
;
Midazolam*
;
Solubility
;
Ventilation
3.Effects of Low and High Frequency Needle Transcutaneous Electrical Nerve Stimulation on Pain Threshold in Normal Adults.
Sang Beom KIM ; Kisung YOON ; Hyun KWAK ; Nam Jin HA ; Yong Eon LEE
Journal of the Korean Academy of Rehabilitation Medicine 1999;23(3):636-642
OBJECTIVE: This study was conducted to compare the effects of low frequency needle transcutaneous electrical nerve stimulation (TENS) and high frequency needle TENS on experimental pain threshold. METHOD: Twenty two healthy adult subjects were assigned randomly to a low-TENS group or to a high-TENS group. Experimental pain threshold at forearm was determined with pain threshold of electrical simulation using surface electrode and needle electrode. RESULTS: Low-TENS group showed that pain relief was developed after 10 minutes and persisted 3 hours after treatment cessation. Low-TENS group showed a significant increase in experimental pain threshold opposing to high TENS group. CONCLUSION: This results suggest that effect of low frequency needle TENS therapy is better and longer than high frequency needle TENS therapy.
Adult*
;
Electrodes
;
Forearm
;
Humans
;
Needles*
;
Pain Threshold*
;
Transcutaneous Electric Nerve Stimulation*
;
Withholding Treatment
4.Effect of humidity on postmortem Pathology changes in rats
Seroc OH ; Byeongwoo AHN ; Beom Jun LEE ; Sang-Yoon NAM
Journal of Veterinary Science 2024;25(3):e24-
Objective:
This study aimed to improve the accuracy of PMI estimates in veterinary forensic cases by looking into how different humidity levels affect autolysis in different organs of rats.
Methods:
The study involved 38 male rats, examining histopathological changes in their heart, liver, and pancreas. These organs were subjected to controlled humidity levels (20%, 55%, and 80%) at a constant 22°C. Tissue samples were collected at several intervals (0 h, 12 h, 24 h, 3 days, and 8 days) for comprehensive analysis.
Results:
Distinct autolytic characteristics in animal organs emerged under varying humidity conditions. The low-humidity environment rapidly activated autolysis more than the high-humidity environment. In addition, it was found that lower humidity caused nuclear pyknosis, cytoplasmic disintegration, and myofiber interruption. The liver, in particular, showed portal triad aggregation and hepatocyte individuation. The pancreas experienced cell fragmentation and an enlarged intracellular space. High humidity also caused the loss of striations in cardiac tissues, and the liver showed vacuolation. Under these conditions, the pancreas changed eosinophilic secretory granules.
Conclusions
and Relevance: The study successfully established a clear connection between the autolytic process in PMIs and relative humidity. These findings are significant for developing a more accurate and predictable method for PMI estimation in the field of veterinary forensic science.
5.Changes of Lung Compliance in Pediatric Patients after Surgical Correction of Left to Right Shunt.
Eun Sook YOO ; Young Lan KWAK ; Sang Beom NAM ; Jaehyung KIM ; Seung Ho CHOI ; Sang Gun HAN ; Seo Ouk BANG
Korean Journal of Anesthesiology 1998;35(2):315-320
BACKGROUND: Low values of lung compliance have been reported in patients with increased pulmonary blood flow due to intracardiac left to right(L-R) shunt. The compliance had returned to within normal limits 4 to 6 weeks after surgical correction of the shunt. We investigated whether lung compliance was improved immediately after surgical correction of the shunt. METHODS: Fifty four pediatric patients who were undergoing repair of intracardiac L-R shunt were evaluated. Lung compliance, arterial oxygen tension(PaO2) and arterial to end-tidal carbon dioxide tension difference(Pa-ETCO2) were measured after induction of anesthesia and at the completion of surgery. Left atrial pressure(LAP) was monitored. Lung compliance and end-tidal carbon dioxide tension were measured by monitoring system built in Cato anesthetic ventilator system. RESULTS: Lung compliance was significantly lower after surgery(6.57+/-6.46 ml/mbar) than after induction of anesthesia(7.71+/-7.18 ml/mbar). After surgery, PaO2 was significantly decreased and Pa-ETCO2 significantly increased than after induction of anesthesia. The decrease in lung compliance after surgery significantly correlated with a decrease in PaO2(r=0.43) and an increase in Pa-ETCO2 (r=0.47) but not correlated with LAP. CONCLUSIONS: Although surgical correction of intracardiac L-R shunt reduces pulmonary blood flow, the lung compliance decreases in immediate postoperative period. Therefore a deterioration of postoperative lung compliance may need judicious management for pulmonary and hemodynamic instability.
Anesthesia
;
Carbon Dioxide
;
Compliance
;
Hemodynamics
;
Humans
;
Lung Compliance*
;
Lung*
;
Oxygen
;
Postoperative Period
;
Ventilators, Mechanical
6.Comparison of Hemodynamic Effects between Dobutamine and Amrinone in the Patients with Pulmonary Hypertension.
Yong Woo HONG ; Young Lan KWAK ; Sang Kee MIN ; Sang Beom NAM ; Seo Ouk BANG ; Eun Sook YOO ; Myoung Ouk KIM ; Min Seok KIM
Korean Journal of Anesthesiology 1997;33(5):928-936
BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.
Amrinone*
;
Anesthesia
;
Arterial Pressure
;
Central Venous Pressure
;
Dobutamine*
;
Ethics Committees, Research
;
Hemodynamics*
;
Humans
;
Hydrogen-Ion Concentration
;
Hypertension, Pulmonary*
;
Sternotomy
;
Vascular Resistance
;
Ventilation
7.HgCl2 Toxicity on Cultured Renal Tubular Cells of Rabbit.
Jung Young LEE ; Seong Beom LEE ; Suk Hyung LEE ; Won Sang PARK ; Nam Jin YOO ; Sang Ho KIM ; Choo Soung KIM
Korean Journal of Pathology 1995;29(5):615-623
To understand the mechanism of cell injury when exposed to HgCl2, monitoring of cytosolic ionized free Ca2+([Ca2+]i), viability test, measurement of the amount of ATP, and Ca-ATPase activity were evaluated in cultured rabbit renal tubular cells(RTC) exposed to HgCl2. The results were as follows: 1) HgCl2 was cytotoxic to rabbit RTC at all doses except 10 uM and the rate of killing displayed a dose- and time-dependent relationship. 2) The absence of extracellular Ca provided partial protection from irreversible injury induced by HgCl2. 3) The increasing pattem of [Ca2+]i varied according to the concentrations of HgCl2. At the low concentrations of HgCl2 (2.5-10 microM), the level of [Ca2+]i increased slowly over the flat 2-3 min and then achieved plateau-state. In contrast, at the high concentrations of HgCl2 (25-100 microM) the level of [Ca2+]i achieved peak within 1 min and then decreased to a plateau state under normal concentrations. 4) The level of ATP was decreased to 27.5% of that of normal control cells within 3 min by using a treatment of 100 microM HgCl2. 5) HgCl2 did not affect the Ca2+ ATPase activity by enzyme histochemical observation. These findings suggest that the elevation of [Ca2+]i in response to the HgCl2-induced injury is an important event in accelerating injury that ultimately leads to cell death. But other possibilities such as HgCl2 might have direct deleterious effects on the also should be considered.
Rabbits
;
Animals
8.Efficacy of the Laryngeal Tube in General Anesthesia.
Kee Young LEE ; Chul Ho CHANG ; Sang Beom NAM ; Yon Hee SHIM ; Cheol Oh LEE ; Jong Seok LEE
Korean Journal of Anesthesiology 2003;45(6):687-692
BACKGROUND: A prototype airway management device, a laryngeal tube, has been recently introduced in Korea. This study was designed to assess the efficacy of the laryngeal tube for airway management under general anesthesia. METHODS: We studied thirty-six ASA physical status I and II patients undergoing general anesthesia. Anesthesia was induced with sleep dose propofol 2.0 mg/kg i.v., supplemented with fentanyl 1 microgram/kg, and maintained with 50% nitrous oxide and propofol. After inserting the laryngeal tube, its cuff was inflated using a balloon cuff gauge until the intracuff pressure reached approximately 65 cmH2O. Adequacy of ventilation was assessed by observing the end tidal carbon dioxide wave form, chest wall movement and by stethoscope auscultation. Oropharyngeal leak pressure was also measured. Changes in heart rate, blood pressure, end-tidal carbon dioxide, airway pressure and oxygen saturation before induction, before insertion, 2, 5 and 10 minutes after insertion and 5 minutes after incision were recorded. RESULTS: The first time success rate at achieving an effective airway was 30 in 36 (83%). The mean leak pressure was 22.9+/-4.6 mmHg. Heart rate, blood pressure, oxygen saturation, end-tidal carbon dioxide and airway pressure values remained stable during laryngeal tube insertion and during the surgical procedure. CONCLUSIONS: We conclude that the laryngeal tube is easy to place, allows adequate ventilation and has a lower incidence of complications. It may offer an alternative device for the oxygenation of non-intubated patients undergoing general anesthesia.
Airway Management
;
Anesthesia
;
Anesthesia, General*
;
Auscultation
;
Blood Pressure
;
Carbon Dioxide
;
Fentanyl
;
Heart Rate
;
Humans
;
Incidence
;
Korea
;
Nitrous Oxide
;
Oxygen
;
Propofol
;
Stethoscopes
;
Thoracic Wall
;
Ventilation
9.The Anesthetic Management of the Patient with a Mediastinal Mass: A case report.
Won Sun PARK ; Sang Beom NAM ; Jin Mo AHN ; Sou Ouk BANG ; Yong Woo HANG
Korean Journal of Anesthesiology 1999;36(1):138-142
General anesthesia for the removal of a large mediastinal mass has been associated with life-threatening airway obstruction. We present a case of general anesthesia for a patient with superior posterior mediastinal mass and critical airway compression who was allowed to maintain spontaneous ventilation throughout general anesthesia for a thoracotomy. The patient was a 5-year-old boy complaining of productive cough and intermittent fever for 3 weeks. His chest radiograph and magnetic resonance imaging(MRI) film demonstrated a critically narrowed and deviated trachea at the level of the thoracic inlet to the proximal portion of the right bronchus. We can secure the airway by spontaneous ventilation without muscle relaxation and allowing the patient to breathe spontaneously and insertion of endotracheal tube distal to the narrowed portion of trachea.
Airway Obstruction
;
Anesthesia, General
;
Bays
;
Bronchi
;
Child, Preschool
;
Cough
;
Fever
;
Humans
;
Male
;
Muscle Relaxation
;
Radiography, Thoracic
;
Thoracotomy
;
Trachea
;
Ventilation
10.Changes in Ionized and Total Magnesium Concentration during Spinal Surgery.
Chul Ho CHANG ; Sang Beom NAM ; Jong Seok LEE ; Dong Woo HAN ; Hyun Kyu LEE ; Cheung Soo SHIN
Korean Journal of Anesthesiology 2007;52(6):S37-S41
BACKGROUND: The incidence of postoperative hypomagnesemia in patients undergoing spinal surgery has been reported to be 70%. Ionized magnesium is considered to be the biologically active form, but until the early 1990s, only the total magnesium concentration could be measured. Currently, the ionized magnesium concentration as well as total magnesium concentration can be assessed due in part to the development of a selective electrode. The aim of this study was to more fully characterize the changes in the total and ionized magnesium concentrations in patients undergoing elective spinal fusion surgery. METHODS: The total and ionized magnesium, creatinine, albumin, urinary magnesium concentration, hematocrit, total amount of fluid administration, transfusion, blood loss, and urine output were evaluated both preoperatively and postoperatively in each patient. RESULTS: The total and ionized magnesium concentrations decreased from 0.783 mM/L and 0.529 mM/L preoperatively to 0.717 mM/L and 0.511 mM/L during the postoperative period, respectively. CONCLUSIONS: The incidence of total hypomagnesemia during spinal surgery was 15% but the incidence of ionized hypomagnesemia was only 3%.
Blood Transfusion
;
Creatinine
;
Electrodes
;
Hematocrit
;
Humans
;
Incidence
;
Magnesium*
;
Postoperative Period
;
Spinal Fusion