BACKGROUND: Spinal anesthesia causes hypotension and bradycardia due to sympathetic nerve block and it is difficult to predict the level of sensory block and the duration of blockade. Recent studies have reported that intravenous phenylephrine can reduce the rostral spread of spinal anesthesia in pregnant women. We think a phenylephrine infusion will be useful for maintaining the baseline blood pressure by reducing the rostral spread of spinal anesthesia during the elective surgery of non-obstetric patients. METHODS: Sixty patients who were undergoing urologic surgery were randomized into two groups: Group C (the control group without phenylephrine) and Group P (with the addition of phenylephrine). After a bolus infusion of 50 microg phenylephrine following the spinal injection, phenylephrine was continuously infused at the rate of 200 microg/hr. We compared the dermatomal spreads of spinal anesthesia, the hemodynamic parameters (blood pressure, heart rate) and the incidences of hypotension between the two groups. RESULTS: At 20 minutes, the level of the upper dermatome blocked against cold sensation was a median of T8 (interquartile range: T8-T10) for the phenylephrine group, as compared with T4 (interquartile range: T4-T6) for the control group (P < 0.001). CONCLUSIONS: Intravenous phenylephrine can decrease the rostral spread of spinal anesthesia during urologic surgery.
Anesthesia, Spinal ; Autonomic Nerve Block ; Blood Pressure ; Bradycardia ; Cold Temperature ; Female ; Heart ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Injections, Spinal ; Phenylephrine ; Pregnant Women ; Sensation

In 25 aortic regurgitation patients relationship between degree of aortic regurgitation graded by 2-D color Doppler echocardiography and diastolic fluttering of anterior mitral leaflet on M-mode echocardiography was evaluated. The results were that all 13 aortic regurgitation patients, not associated with mitral stenosis, showed diastolic fluttering of anterior mitral leaflet; but only 3 patients among 12 patients (25%), associated with mitral stenosis, had characteristic mitral fluttering. On the whole, regardless of associated mitral stenosis, the sensitivity was 64%. In severe aortic regurgitation (Grade 3, 4 group) 12/13 patients revealed diastolic fluttering of anterior mitral leaflet (sensitivity of 92%); in mild to moderate aortic regurgitation (Grade 1, 2 group), only 4/12 patients (sensitivity of 33%). In conclusion, 2-D color Doppler echocardiography is a very useful method for detection of aortic regurgitation without difficulty. And in aortic regurgitation, not associated with mitral stenosis, fine fluttering of anterior mitral leaflet is a very sensitive sign of existence of aortic regurgitation, though there may be some false positive findings in normal individuals.
Aortic Valve Insufficiency* ; Echocardiography ; Echocardiography, Doppler, Color* ; Humans ; Mitral Valve Stenosis

BACKGROUND: Reperfusion injury often develops after cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG), and MgSO4 is known to be related to such injury. The goal of this study was to determine the hemodynamic and oxygen metabolic effects of administering MgSO4 after cessating cardiopulmonary bypass during coronary bypass surgery in control and nicardipine infusion groups. METHODS: After obtaining hospital ethics committee clearance, we studied 29 patients with coronary artery disease scheduled for CABG, who were randomly assigned to receive nicardipine (0.5 microgram/kg/min, n = 11) or placebo (n = 18). All patients were administered MgSO4 (60 mg/kg) after the cessation of CPB. The hemodynamic variables and oxygen parameters were recorded and calculated by continuous cardiac output and mixed venous oxygen saturation monitoring, through a thermodilution Swan-Ganz catheter before and 20 minutes after MgSO4 administration. RESULTS: Heart rate was reduced after administering MgSO4 in both groups, and the mean arterial pressure was also reduced in the nicardipine group. The cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, right and left stroke work indices were well-maintained after administering MgSO4. Mixed venous oxygen saturation and other oxygen parameters were maintained without change after MgSO4 administration. CONCLUSIONS: The present study shows that MgSO4 can be used without inducing any significant oxygen metabolism or hemodynamic derangements during CABG. But further work is needed to elucidate the myocardial protective effects of MgSO4.
Arterial Pressure ; Cardiac Output ; Cardiopulmonary Bypass ; Catheters ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Ethics Committees, Clinical ; Heart Rate ; Hemodynamics* ; Humans ; Metabolism ; Nicardipine ; Oxygen ; Reperfusion Injury ; Stroke ; Thermodilution ; Vascular Resistance

Isolated true atherosclerotic aneurysm of the distal superficial femoral artery is rare disease. We experienced a case of distal superficial femoral artery aneurysm not associated with dilatation of the common femoral or popliteal artery. True arterial aneurysms are attributed to the weakening of the arterial wall due to atherosclerosis. True superficial femoral artery aneurysms were predominantly founded in elderly men and used to be diagnosed by ultrasonography, CT or angiogram. We report a case of distal superficial femoral arterial aneurysmal rupture in elderly woman who has a rheumatoid athritis and diagnosed by ultrasonography. We performed aneurysmal excision and interposition graft with PTFE.
Aged ; Aneurysm* ; Arteries ; Arthritis, Rheumatoid* ; Atherosclerosis ; Dilatation ; Female ; Femoral Artery ; Humans ; Male ; Polytetrafluoroethylene ; Popliteal Artery ; Rare Diseases ; Rupture* ; Transplants ; Ultrasonography

No abstract available.
Adult* ; Humans ; Korea* ; Prevalence* ; Seoul* ; Urolithiasis*

Although myocardial stunning occurs in coronary artery disease, it has rarely been reported with hyperthyroidism. A 72-year-old woman presented with general weakness, shortness of breath and febrile sensation of 10 days duration. The serum thyroid hormone level was elevated. Serial EKGs showed significant ST elevation suggesting transmural ischemia, but coronary angiography was not significant. Echocardiography showed regional wall motion abnormality of apical hypokinesia, which was improved after medication for hyperthyroidism. We report this case as an example of myocardial stunning associated with hyperthyroidism.
Aged ; Coronary Angiography ; Coronary Artery Disease ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Humans ; Hyperthyroidism* ; Hypokinesia ; Ischemia ; Myocardial Stunning* ; Sensation ; Thyroid Gland

Although myocardial stunning occurs in coronary artery disease, it has rarely been reported with hyperthyroidism. A 72-year-old woman presented with general weakness, shortness of breath and febrile sensation of 10 days duration. The serum thyroid hormone level was elevated. Serial EKGs showed significant ST elevation suggesting transmural ischemia, but coronary angiography was not significant. Echocardiography showed regional wall motion abnormality of apical hypokinesia, which was improved after medication for hyperthyroidism. We report this case as an example of myocardial stunning associated with hyperthyroidism.
Aged ; Coronary Angiography ; Coronary Artery Disease ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Humans ; Hyperthyroidism* ; Hypokinesia ; Ischemia ; Myocardial Stunning* ; Sensation ; Thyroid Gland

We experienced a case, which showed the sudden drop of arterial oxygen saturation and capnographic score in a femur surgery patient under general anesthesia. We installed a transesophageal echocardiography probe in the patient and detected free-floating emboli in the right atrium, enlargement of the right atrium and the right ventricle, and global hypokinesia of the right ventricle. Because the patient's vital sign was so unstable, emergent cardiac and pulmonary embolectomy was performed with the use of cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged without any neurologic sequale. We concluded that transesophageal echocardiography was a useful device for the diagnosis of intraoperative massive pulmonary thromboembolism.
Anesthesia, General ; Cardiopulmonary Bypass ; Echocardiography, Transesophageal ; Embolectomy ; Femur ; Heart Atria ; Heart Ventricles ; Humans ; Hypokinesia ; Oxygen ; Pulmonary Embolism ; Vital Signs

BACKGROUND AND PURPOSE: White-matter (WM) lesions are known to potentiate cognitive impairment in poststroke patients. The present study was designed to assess whether Ginkgo biloba extract (GB) and cilostazol, which were evaluated alone and in a combination formula (Renexin), can attenuate the WM lesions and cognitive decline caused by chronic hypoperfusion in the rat. METHODS: Animals were divided into five treatment groups: cilostazol (25 mg/kg/day), GB (20 mg/kg/day), Renexin (25 mg/kg/day cilostazol + 20 mg/kg/day GB), vehicle, and sham. The animals received the treatments orally 1 day after bilateral common carotid artery occlusion [two-vessel occlusion (2VO); except for the sham group, which underwent the surgery but the arteries were not occluded], and then the same dose every day for 21 days thereafter. Prior to sacrificing the rats, repetitive eight-arm radial maze testing was performed to examine their cognitive abilities. After drug administration and cognitive testing, brain tissues were isolated for Kluver-Barrera and terminal deoxynucleotidyl transferase-mediated biotin-dUTP nick end-labeling (TUNEL) staining, immunohistochemical assessment of glial fibrillary acidic protein (GFAP) and CD11b (OX-42), and to assay free-radical scavenging activity. RESULTS: We found that the significant WM lesions induced by 2VO was ameliorated significantly by treatment with cilostazol, GB, and Renexin, in association with increased TUNEL-positive cells. In addition, chronic cerebral hypoperfusion caused a large increase in the degree of GFAP and OX-42 immunoreactivity and free-radical activity in the optic tract. These abnormalities were significantly reversed by the three drugs, but most prominently by Renexin, suggesting a markedly enhanced or supra-additive effect of cilostazol and GB when administered together. CONCLUSIONS: Significant attenuation of cytoarchitectural damage and apoptotic cell death was found with GB and cilostazol, but a markedly enhanced effect was seen for treatment with their combination in the WM of rat brains after bilateral occlusion of the common carotid arteries. We suggest that combination therapy with GB and cilostazol provides enhanced neuroprotective effects and induces subsequent cognitive improvement in patients with chronic ischemic conditions.
Animals ; Arteries ; Brain ; Carotid Artery, Common ; Cell Death ; Ginkgo biloba ; Glial Fibrillary Acidic Protein ; Humans ; Neuroprotective Agents ; Rats ; Salicylamides ; Tetrazoles ; Visual Pathways

Tracheal rupture is a rare complication of tracheal intubation, but may result in pneumothorax, mediastinal emphysema, subcutaneous emphysema and other serious outcomes. Risk factors associated with tracheobronchial rupture include multiple vigorous attempts at intubation, inexperienced operator, intubating stylets, tracheal abnormalities, overdistension of tracheal or bronchial cuff, repositioning of tube without deflating the cuff, chronic obstructive airway disease and vigorous coughing while being intubated. We report a case of tracheal rupture after using single lumen endotracheal tube. A 41-year-old, 53 kg, female was operated for a repair of anterior cruciate ligament under general anesthesia in other hospital. Two hours later after the end of operation, facial swelling, dyspnea and chest pain developed. Chest computed tomography showed mediastinal emphysema. She was transferred to our hospital and bronchoscopy showed a rupture at posterior part of membranous portion 2 cm proximal to carina. Trachea was repaired and she was discharged from the hospital without complication.
Adult ; Anesthesia, General ; Anterior Cruciate Ligament ; Bronchoscopy ; Chest Pain ; Cough ; Dyspnea ; Emphysema ; Female ; Humans ; Intubation ; Mediastinal Emphysema ; Pneumothorax ; Pulmonary Disease, Chronic Obstructive ; Risk Factors ; Rupture* ; Subcutaneous Emphysema ; Thorax ; Trachea