Pheochromocytoma is functioning tumor which originates in the adrenal medulla or in chromaffin tissue along the paravertebral sympathetic chain. This tumor releases epinephrine and norepinephrine causing increase of peripheral resistance and resulting in increased blood pressure and reducing plasma volume. The anesthetic management of patients with pheochromocytoma presents many difficult problems such as hypertension, cardiac arrhythmias, and hypotension. A 40 year-old female underwent resection of pheochromocytoma under general anesthesia. Thiopental was used for induction followed N2O-O2-enflurane supplemented with fractional doses of fentanyl and vecuronium for muscle relaxation. Hypertensive crisis during induction of anesthesia and surgical manipulation of the tumor were managed with phentolamine and sodium nitroprusside, and premature ventricular beats were controlled with lidocaine. We experienced marked fluctuation of blood pressure during anesthetic course.
Adrenal Medulla ; Adult ; Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Epinephrine ; Female ; Fentanyl ; Humans ; Hypertension ; Hypotension ; Lidocaine ; Muscle Relaxation ; Nitroprusside ; Norepinephrine ; Phentolamine ; Pheochromocytoma* ; Plasma Volume ; Thiopental ; Vascular Resistance ; Vecuronium Bromide ; Ventricular Premature Complexes

No abstract available.
Anesthesia* ; Emergencies*

No abstract available.
Humans ; Intensive Care Units* ; Critical Care* ; Korea*

No abstract available.
Blood Pressure Monitors* ; Blood Pressure* ; Fingers*

A sensitive and simple liquid chromatography-tandem mass spectrometry method was developed and validated for the simultaneous quantification of ticagrelor and its active metabolite, AR-C124910XX from 50 µL human plasma using tolbutamide as an internal standard as per regulatory guidelines. Analytes in plasma were extracted by simple protein precipitation using acetonitrile, followed by chromatographic separation with an Acclaim™ RSLC 120 C₁₈ column (2.2 µm, 2.1 × 100 mm) and a gradient acetonitrile-water mobile phase containing 0.1% formic acid within 8 min. Mass spectrometric detection and quantitation were conducted by selected reaction-monitoring on a negative electrospray ionization mode with the following transitions: m/z 521.11 → 361.10, 477.03 → 361.10, and 269.00 → 169.60 for ticagrelor, AR-C124910XX, and tolbutamide, respectively. The lower limit of quantifications was 0.2 ng/mL with linear ranges of 0.2–2,500 ng/mL (r² ≥ 0.9949) for both analytes. All validation data, including selectivity, cross-talk, precision, accuracy, matrix effect, recovery, dilution integrity, stability, and incurred sample reanalysis, were well within acceptable limits. This assay method was validated using K₂-EDTA as the specific anticoagulant. Also, the anticoagulant effect was tested by lithium heparin, sodium heparin, and K₃-EDTA. No relevant anticoagulant effect was observed. This validated method was effectively used in the determination of ticagrelor and its active metabolite, AR-C124910XX, in plasma samples from patients with myocardial infarction.
Heparin ; Humans ; Lithium ; Mass Spectrometry ; Methods ; Myocardial Infarction ; Pharmacokinetics ; Plasma ; Tolbutamide

BACKGROUND/AIMS: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS. METHODS: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed. RESULTS: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps. CONCLUSIONS: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features.
Abdominal Pain ; Abscess ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cohort Studies ; Constriction, Pathologic ; Follow-Up Studies ; Hand Strength ; Humans ; Pancreatitis, Chronic ; Plastics ; Stents

In the anesthesia for the Cesarean section, the anesthetists should select the agent and technique carefully which is safe for both the mother and baby. If a light plane of general anesthesia is chosen for fetal safety and rapid recovery, there may be increased incidence of maternal recall and intraoperative pain perception. We studied the effect of nalbuphine(N group) and fentanyl(F group) used as main analgesics in balanced anesthesia in 60 full term parturients, ASA physical status class I or II, scheduled for elective Cesarean section. The patients were questioned for recall, pain perception and unpleasant dreams during anesthesia. The results were as follows, 1) The 12 patients had positive reactions. Among them, 3 patients(10%) were in the N group and 9 patients(30%) in the F group. 2) The sedation was more in the N group(30%) than in the F group(6.6%). We concluded that the balanced anesthetic technique using nalbuphine caused less maternal recall and pain perception with more sedation than using fentanyL.
Analgesics ; Anesthesia ; Anesthesia, General ; Anesthetics ; Balanced Anesthesia* ; Cesarean Section* ; Dreams ; Female ; Fentanyl* ; Humans ; Incidence ; Mothers ; Nalbuphine* ; Pain Perception ; Pregnancy

Epidural anesthesia is a technique of regional anesthesia in which the spinal nerves are blocked as they pass through the epidural space. The current study was conducted to determine the extent of contamination of epidural catheters and to attempt to idntify the factors contributing to contamination. The catheters removed from fifty patients were studied, two cultures were taken from each catheter and the following results were obtained. 1) Catheter tips(20%) in ten cultures and portions of the catheter located in the subcutaneous tissue in nine cultures(18%) were found to be contaminated. 2) Staphylococcus epidermidis was found in eight patients, and staphylococcus aureus and xanthomonas maltophilia were found in two patients each other. 3) In the contaminated populations, no significant difference between the growth rate of organisms and the factors in relation to the duration of catheter implantation, age of the patients and the site of catheter inserition was found.
Analgesia, Epidural* ; Anesthesia, Conduction ; Anesthesia, Epidural ; Catheters* ; Epidural Space ; Humans ; Spinal Nerves ; Staphylococcus aureus ; Staphylococcus epidermidis ; Stenotrophomonas maltophilia ; Subcutaneous Tissue

In Korea, the study about the normal depth of insertion of dauble lumen tubes bas not been reported yet. So we studied 50 adult patients(30 males and 20 females) undergoing thoracic surgery under one lung ventilation. Endotracheal intubation was done with the disposable polyvinylchloride Robertshaw-type double lumen endobronchial tube. The exact position of a left-sided double lumen endobronchial tube was confirmed by passing a fiberoptic bronchoscope through the tracheal lumen of the double lumen, The depth was measured when we had a view of a clear straight-ahead view of the tracheal carina, the right lumen going off to the right, and the upper surface of the blue left endobronchial balloon just below the tracheal carina, The resullts were as follows; 1) In the male patients, the average depth of the tube was 30.7+/-1.4cm and this measure- ments were related with height but not the weight and age. 2) In the female patients the average depth of the tube was 28,3+/-l.2cm and this measurements were unrelated with height, age and weight. 3) Among the male and female patients the average depth of the tube was 30.0+/-1.8cm and this measurements were related with a height but not with weight and age.
Adult ; Bronchoscopes* ; Female ; Humans ; Intubation, Intratracheal ; Korea ; Male ; One-Lung Ventilation ; Thoracic Surgery

The development of endoscopic video systems and instrumentation has allowed therapeutic thoracoscopy for peripheral lung resection, pleural biopsy, open lung biopsy, closure of leaking blebs, parietal pleurodesis, and perieardiectomy and biopsy. The purpose of this study is to investigate the cardiovascular effects and blood gas changes during thoracoscopic surgery with one-lung ventilation and intrathoracic CO2 insufflation to collapse the affected site of the lung and so to get optimal surgical field under lateral position. Measurements of cardiac index, systemic vascular resistance, central venous pressure, heart rate, mean arterial blood pressure, and end-tidal PCO2 were done in twenty three patients who underwent bleb resection via thoracoscopy with intrathoracic CO2 insufflation. Each measurement was done 10 minutes after tracheal intubation(control), 10 minutes after position change, l0 minutes after one-lung ventilation, 30 minutes after CO2 insufflation, 1 hour ater CO2 deflation, and 6 hours after CO2 deflation. Also the measurement of arterial blood gas was done before anesthesia and used as a control. The results were as follows; 1) End-tidal PCO2 was increased after CO2 insufflation. 2) Arterial PCO2 was increased after CO2 insufflation and until 1 hour after CO2 deflation, and the value measured 6 hours afer deflation was recovered to the preanesthetic value. 3) Arterial PO2 was decrease after one-lung ventilation, but there was no change after CO2 insufflation. 4) Mean arterial blood pressure was increased after one-lung ventilation, after CO2 insufflation, 1 hour after CO 2 deflation and 6 hours after CO2 deflation from the control values respectively. 5) Heart rate was decreased after position change, and until one-lung ventilation, but it was increased after CO2 insufflation. 6) Central venous pressure was increased after position change, after one-lung ventilation and after CO insufflation. 7) Cardiac index waa increaeed after CO2 insufflation compared to the immediately preceding values. 8) Systemic vascular resistance was not changed throughout the procedure.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Biopsy ; Blister ; Central Venous Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Insufflation* ; Lung ; One-Lung Ventilation ; Pleurodesis ; Rabeprazole ; Thoracoscopy* ; Vascular Resistance ; Ventilation