No abstract available.
Diazepam* ; Hemodynamics* ; Morphine* ; Pancuronium* ; Respiration, Artificial*

Coronary artery disease is an ever-increasing problem to anesthesiologists as more patients with severe coronary artery are being accepted for surgery. Four cases of aortocoronary bypass graft procedure were done at Severance hospital. The procedure itself can result in perioperative myocardial infarction leading to death. Greater understanding of and constant attention to the myocardial oxygen supply and demand may reduce the incidence of perioperative myocardial infarction. Among the four patients, three tolerated the anesthesia and surgery well without gross pre and postoperative complications. However one patient developed hypotension in the recovery room and died 6 hours postoperatively, in spite of an intensive efforts at resuscitation. The problems, complications and precautions for anesthesia are discussed.
Anesthesia* ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Hypotension ; Incidence ; Myocardial Infarction ; Oxygen ; Postoperative Complications ; Recovery Room ; Resuscitation ; Transplants

Midazolam, a water-soluble benzodiazepine that is shorter-acting, more potent, and less irritating to veins than diazepam, has been suggested for use for induction of anesthesia. The cardiovascular effects of an induction dose(0.2~0.3mg/kg) of midazolam in ASA class lll cardiac surgical patients (N=15) were compared in a couble-blind fashion with a similar group of patients (N=15) receiving thiopental (5.0mg/kg). The patients were premedicated by triflupromasine, pethidine, hydroxyzine, atropine and diazepam. The results were summarized as follows. 1) The thiopental group were more decreased in blood pressure and increase in heart rates than midazolam group. 2) Spontaneous eye closing time and loss of eyelash reflexes were observed. But those were a poor sign of adequate induction became of heavy preanesthetic sedation. 3) The changes of blood pressure and pulse rate after induction and intubation were almost similar in the two groups, but greater individual variation was seen in midazolam groups, depends on preload state before induction. From the above results, midazolam was sufficient as an induction agent for open heart cases. But a hypovolemic patients and completely beta blocked patients should be used cautiously because they may be developed severe hypotension and tachycardia.
Anesthesia ; Atropine ; Benzodiazepines ; Blood Pressure ; Diazepam ; Heart Rate ; Heart* ; Humans ; Hydroxyzine ; Hypotension ; Hypovolemia ; Intubation ; Meperidine ; Midazolam* ; Reflex ; Tachycardia ; Thiopental ; Thoracic Surgery* ; Veins

Introduction: Oxygen delivery to tissue is of major clinical interest in patients with cyanotic congenital heart disease (CHD). The use of pulse oximeter to monitor arterial oxygen saturation (SaO2) is considered accurate and reliable in the range of 90% to 100%. However with desaturation, the accuracy remains controversial below 90%. The aim of this study was to evaluate the accuracy of pulse oximetry in severe hypoxemia. METHOD: In 110 children with cyanotic CHD, pulse oximeter (N-200, Nellcor, USA) readings were compared with the direct measurement of SaO2 by blood gas analyser (Profile10, Stat, USA). All measurements were carried out after induction of anesthesia and devided into 4 groups according to saturation measured by pulse oximeter (SpO2). SpO2 in group I was higher than 90% (n=90), in group II between 80% and 89% (n=75), in group III between 70% and 79% (n=41), in group IV lower than 69% (n=18). Statistical analysis of paired SpO2 and SaO2 values was performed using correlation analysis and paired t-test. The other comparisons were perfomed with ANOVA. p<0.05 was considered statistically significant. RESULTS: Correlation coefficient of group I was 0.89 (p<0.01), group II was 0.67 (p<0.01), group III was 0.63 (p<0.01) and group IV was 0.41. The study demonstrate that SpO2 seems to have good correlation with SaO2 when SpO2 is higher than 70%. This results are contrary to other studies which show that SpO2 is not reliable when SpO2 is below 90%. However, the correlation value r seems to decrease with desaturation. CONCLUSION: The use of pulse oximeter in severe hypoxemic children with CHD is efficient in monitoring oxygenation, even though there is decrease in accuracy of the SpO2.
Anesthesia ; Anoxia ; Child* ; Heart Defects, Congenital* ; Humans ; Oximetry* ; Oxygen ; Reading

As the mitral valve disease becomes long-standing, the patient may develop pulmonary hypertension. It was reported that after surgical correction, the elevated pulmonary vascular resistance(PVR) would fall quickly in association with the fall in left atrial pressure(LAP). This study was performed to evaluate the changes in mean pulmonary artery pressure(PAP) and PVR immediately after mitral valve replacement(MVR). Fifty six patients undergoing mitral valve replacement(MVR) were divided into two groups on the basis of the presence or absence of significant pulmonary hypertension, defined as a resting mean pulmonary arterial pressure greater than 30mmHg. After induction of anesthesia, PAP, PVR, cardiac output(CO) were measured and compared with values in postbypass period. PAP and PVR were significantly decreased(PAP from 39.64+/-1.88 to 29.18+/-1.65 mmHg, P 0.001, PVR from 6.16+/-1.14 to 3.53+/-0.62 units, P<0.05) in Group II(PAP> or = 30mmHg, n=23), whereas not changed in Group I(PAP30 mmHg, n=33)(P<0.05). Persistance of an elevated PVR may cause right ventricular failure and low-output syndrome, so that an attempt to reduce the PVR is needed postoperatiavely. This study demonstrated that the PAP and PVR fall significantly after MVR especially in patients with severe pulmonary hypertension.
Anesthesia ; Arterial Pressure* ; Humans ; Hypertension, Pulmonary ; Mitral Valve* ; Pulmonary Artery ; Vascular Resistance*

In order to evaluate the effect on cardiopulmonary fuaction and the relaxation brought about by atracurium elective surgical patients, belonging to ASA class 1 or 2 were anesthetixed with thiopental (5-6mg/kg) and intubated after atracurium injection through a central venous catheter. The changes of blood pressure, heart rate, the degree af relaxation and the time interval between atracurium and intubation were observed. The results are as follows 1) There was an average drop of 20mmHg in the systolic blood pressure and an average rise of 12 beate/min, in the pulse after thiopental (p<0.05), and no more significant changes were observed following atracurium. But significant rises of both were observed after intubation. 2) Following an atracurium injection of 0.62+/-0.01mg/kg, the time interval between atracurium and intubation was 167.78+/-11.15 sec. 3) Vocal cord relaxation was poor in 7 of 9 cases, so intubation was somewhat difficult. From the above results, the effect of atracurium for intubation was not satisfactory in this study. The potency of the atracurium may have changed due to unsuitable preservation at room temperature. Other causes for the lack of relaxation may have been the succesaive injection of thiopental and insufficient doses of atracurium.
Atracurium* ; Blood Pressure ; Central Venous Catheters ; Heart Rate ; Humans ; Intubation ; Relaxation ; Thiopental ; Vocal Cords

Cardiac catheterization has been used as an essential diagnostic procedure since 1929 when initiated by Forssman. Anesthesis in an infant will change BP and respiration and thus the diagnostic results may be effected. It is desirable to minimize these effects and still give safe anesthesia. To solve these problems some authors have recently reported on the use of ketamine for anesthesia. Ketamine has simple and rapid induction, easy maintanance of airway and respiration without intubation or extra oxygen supply (Stanley et al, 1969, Coppel and Dundee, 1972). But it causes a rise of BP and pulse rate(Domino et al 1965: Roberts, 1967: Phillips et al, 1970) which may effect the results of catheterization. In the present clinical study to evaluate the effect of ketamine on BP, pulse and pulmonary artery pressure, 47 congenital heart cases were randomly divided into 2 groups. In group l the effect of ketamine on BP EKG and respiration was studied on 37 patients undergoing cardiac catheterization and angilgram. The average age was 4 years with a range from 1/2 to 13 years, and the weight averaged 14kg with a range from 6 to 40kg. In group 2, a cathether was inserted into the main pulmonary artery under local anesthesia and the pressure was measured before and after l.V. ketamine (1mg/kg) in 10 cases in which the age was around 7years(range 3~13 years) and the body weight around 19kg(range 11~32kg). The following results were obtained: 1. Mean blood pressure significantly increased from 82.7+/-1.8mmHg to 91.8+/-2.0mmHg in 1 min. after l.V. ketamine and lasted around 4min. The pulse rate increased from 125.9+/-4.1min. to 131.9+/-4.3min in 1 min. after ketamine and lasted about 2 min. 2. Immediately after angiogram the blood pressure significantly decreased from 111.7+/-2.8/70.0+/-2.3mmHg to 88.0+/-2.4/51.6+/-2.4mmHg in group l. 3. The amin pulmonary artery pressure increased significantly form 41.9+/-7.16/16.4+/-4.8mmHg to 50.8+/-8.7/23.7+/-5.8mmHg. The mean pulmonary artery pressure difference was 8.1+/-0.9mmHg after ketamin I.V. injection and the mean aorta pressure difference at the time was 11.2+/-2.2mmHg in group 2. 4. No. other findings were observed. From the above results, although ketamine obviously raised pulmonary artery pressure and blood pressure during cardiac catheterization, there was no intereference in diagnosing the condition. It suggests that the use of ketamin is a safe method when cardiac catheterisation is performed in children with cardiac problems except when there is severe pulmonary hypertension.
Anesthesia* ; Anesthesia, Local ; Aorta ; Blood Pressure ; Body Weight ; Cardiac Catheterization* ; Cardiac Catheters* ; Catheterization ; Catheters ; Child ; Electrocardiography ; Heart ; Heart Rate ; Humans ; Hypertension, Pulmonary ; Infant ; Intubation ; Ketamine* ; Oxygen ; Pulmonary Artery ; Respiration

At present glucose solution is commonly used as the priming solution in cardiopulmonary bypass and an elevated blood glucose level is seen throughout and following bypass. The relationship between elevated blood glucose levels and plasma insulin response during cardiopulmonary bypass has not been clearly established. Plasma immunoreactive insulin and blood glucose levels were studied in 13 adult patients undergoing open heart surgery with cardiopulmonary bypass. The following results were obtained: 1) With body cooling, plasma insulin levels fell despite the oevelopment of hyperglycemis. On rewarming plasma insulin levels rose markedly and blood glucose levels remained high until the procedure was ended. 2) During cardiopulmonary bypass, serum sodium levels did not show any marked fluctuation, but serum potassium levels were low compared to control values.
Adult ; Blood Glucose ; Cardiopulmonary Bypass ; Glucose* ; Heart* ; Humans ; Insulin ; Plasma ; Potassium ; Rewarming ; Sodium ; Thoracic Surgery*

We had examined the invasive blood pressure monitoring of superficial temporal, radial and femoral artery in two eases of Takayasus syndrome with mitral regurgitation and acute renal artery infarction. Mitral valve replacement and aorto-renal bypass graft were done by using cardiopulmonary bypass and one-lung ventilation respectively, The results are ; 1) Superficial temporal artery monitoring was more reliable and less fluctuant than femoral and radial artery monitoring in blood pressure. But we dont know the relationship of adequate cerebral perfusion pressure and superficial temporal artery pressure. 2) The femoral artery pressure monitoring was not adequate when the patients had a problem with ascending and descending aorta patency. 3) We had good results in the patient management by the monitoring of superficial temporal artery pressure.
Aorta, Thoracic ; Blood Pressure Monitors* ; Blood Pressure* ; Cardiopulmonary Bypass ; Femoral Artery ; Humans ; Infarction ; Mitral Valve ; Mitral Valve Insufficiency ; One-Lung Ventilation ; Perfusion ; Radial Artery ; Renal Artery ; Temporal Arteries ; Transplants

Removal of a left atrial myxoma using extracorporeal circulation was successfully performed first in 1954 by Craford. The problems of anesthesia for resection of atrial myxoma were the hemodynamic alterations, embolisation and valvular obstruction produced by tumor size and location, conduction defects due to myocardial invasion and anesthetic and operative procedures. Thus we have mad clinical analysis of 13 cases receiving anesthesia performend from 1976 to 1983 at Severance Hospital, Yonsei University College of Medicine. The results of clinical analysis are as follows: 1) Atrial myxomas were located(in the) in the lefte atrium except for 1 case. 2) Preoperatively most of these case showed congestive heart failure, cardiomegaly, arrhythmia and increased right atrial, pulmonary arterial and pulmonary capillary wedge pressures. 3) As premedicantes, one of the sedatives and a mild tranquilizer were given in all cases, atropine in about one third and triflupromaxine in about one half of the cases. 4) Anesthesia was induced with thiopental, morphine, midazolam, flunitrozepam and intubated after succinylchoilne or pancuronfum and maintained in the usual manner. 5) Myoxamas were resected during cardiopulmonary bypass and one case had to have a mitral value replacement. 6) The average duration of anesthesia and bypass was 372.14+/-42.0 and 104+/-12.9min. No mortality occurred. From the above results, it can be concluded that the understanding of the pathophysiology and the hemodynamic changes before anesthesia are important for safe anesthesia.
Anesthesia* ; Arrhythmias, Cardiac ; Atropine ; Capillaries ; Cardiomegaly ; Cardiopulmonary Bypass ; Extracorporeal Circulation ; Heart Failure ; Hemodynamics ; Hypnotics and Sedatives ; Midazolam ; Morphine ; Mortality ; Myxoma* ; Pulmonary Wedge Pressure ; Surgical Procedures, Operative ; Thiopental