We experienced a case of Cesarean section of Marfan syndrome under the general anesthesia. Marfan syndrome is an autosomal dominant trait characterized by generalized defect of connective tissue, which is mediated by a structural deficiency in Type 1 collagen. Its prevalence has been estimated at 1 to 5 in 100,000. Expression of the trait is variable but the most common diagnostic signs are disproportionate length of long bones, hypermobility of joints, prolapsed lens, and cardiac murmurs, most often the systolic click-murmur of mitral valve prolapse. The importance in anesthetic management of these patients should be chosen to prevent any hypertension in response to intubation and surgery, and handled very gently, with minimal stress placed on the connective tisues.
Anesthesia, General* ; Cesarean Section ; Collagen Type I ; Connective Tissue ; Female ; Heart Murmurs ; Humans ; Hypertension ; Intubation ; Joints ; Marfan Syndrome* ; Mitral Valve Prolapse ; Pregnancy ; Prevalence

Background: It has been reported that steroid and lidocaine reduce inflammatory responses to endotoxin. The aim of this study is to compare the effects of lidocaine with those of steroid on inflammatory responses to Escherichia coli endotoxemia in the rabbit lung. Methods: Twenty four animals were randomly assigned to one of four groups. Group I (endotoxemic group; control, n=6): They were received E. coli endotoxin (500 microg/kg) intravenously through the ear vein and followed by saline infusion at 20 ml/kg/hr for 4 hours. Group II (steroid treated group, n=6): They were treated with steroid (30 mg/kg) intravenously just after endotoxin injection and then saline was given at 20 ml/kg/hr for 4 hours. Group III (lidocaine treated group, n=6): They were received same as the endotoxemic group and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered with saline at 20 ml/kg/hr for 4 hours. Group IV (steroid & lidocaine treated group, n=6): They were received same as the endotoxemic group and after endotoxin infusion, steroid (30 mg/kg) and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered intravenously with saline. Numbers of neutrophils and monocytes in the samples of peripheral blood and lung tissue were counted and compared to evaluate the anti-inflammatory effect of drugs. Results: The group II, III, and IV showed significant attenuation of inflammatory responses compared to group I in the rabbit lung(P<0.05). But there were no significant differences among group II, III, and IV. There was no additive effect between steroid and lidocaine. Conclusion: These results suggest that lidocaine could be used as an alternative drug to steroid for its anti-inflammatory effects and cost-effectiveness.
Animals ; Ear ; Endotoxemia* ; Escherichia coli ; Lidocaine* ; Lung* ; Monocytes ; Neutrophils ; Veins

BACKGROUND: The univent tube is an endotracheal tube with a movable bronchial blocker for one lung ventilation. The purpose of this study was to measure the appropriate cuff volume sealing the mainstem bronchus by three different techniques. METHODS: This study was performed in 60 adult patients undergoing thoracotomy. 1) The negative pressure was applied to the end of blocker causing loss of volume in the breathing system. The blocker cuff volume was measured at the point of the bag ceased to deflate. 2) The blocker cuff volume was measured when breathing sound is not heard on blocked lung. 3) Then the capnometer was applied to the blocker and the cuff volume was measured at the point of the CO2 wave ceased abruptly. The bronchial blocker volumes from these three methods were compared with the volume which was measured when the lung was completely collapsed in operation field. RESULTS: Left bronchial sealing volume was 2.7+/-?0.8 ml with negative pressure technique, 3.5+/-0.8 ml with auscultation, 3.2?1.2 ml with CO2 technique and 3.0+/-0.7 ml with complete lung collapse at operation field. Right bronchial sealing volume ranged 3.5+/-0.9 ml with negative pressure technique, 4.6+/-1.0 ml with auscultation, 3.9+/-0.6 ml with CO2 technique and 4.2+/-0.9 ml with complete lung collapse at operation field. CONCLUSIONS: We concluded that right bronchial blocker volume was 4.2+/-0.9 ml and left bronchial blocker volume was 3.0+/-0.7 ml. The right bronchial blocker volume was larger than the left.
Adult ; Auscultation ; Bronchi ; Humans ; Lung ; One-Lung Ventilation* ; Pulmonary Atelectasis ; Respiration ; Respiratory Sounds ; Thoracotomy

We successfully managed one-lung ventilation in a 5-yr-old boy who underwent thoracoscopic removal of an emphysematosed right lower lobe. We used a 5-French 70 cm balloon-tipped Fogarty embolectomy catheter as a bronchial blocker. Its single lumen, which ends blindly, contains a guidewire and is used to inflate a spherical balloon. First, we threaded the distal end of the blocker through the Murphy hole of a 5.5 cuffed endotracheal tube. The tip of the blocker was adjusted to the end of the endotracheal tube, and the remainder of the blocker was attached closely to the outer wall of the tube and fixed once at the neck of the tube with tape. The tube and catheter were intubated as a set. After intubation, a bronchoscope was introduced through the tube. Under bronchoscopic view, Fogarty catheter was drawn back by 1 2 cm to withdraw the catheter tip from the Murphy hole and then advanced until the balloon tip reached the right main bronchus. With balloon inflation, we were able to achieve satisfactory one-lung ventilation.
Bronchi ; Bronchoscopes ; Catheters ; Embolectomy ; Humans ; Inflation, Economic ; Intubation ; Male ; Neck ; One-Lung Ventilation*

A retrospective analysis according to age, sex, department, anesthetic method and disease were performed on 4,732 pediatric anesthetized patients(under 6 years old) who had received operations from March 1983 to February 1993. The results were as follows; 1) Age ; The average age distribution in descending order was 75.9% in group between 1 and 6 years, 11.0% in group between 6 months and 1 year, 9.3% in group between 1 and 6 months, and 3.8% in group under 1 month. 2) Sex ; The male to female ratio was 65.3% to 34.7%. 3) Department; The average distribution of the patient by department in descending order was general surgery (26.6%), plastic surgery (17.4%), otolaryngology (16.7%); opbthalmology (14.8%),orthopedic surgery (14.2%), urology (7.1%), neurosurgery (2.5%) and ofhers (0.7%). 4) Anesthetic method; Most cases (86.7 %) were performed endotracheal intubation. 5) Disease; Most common diseases in order were infection (22.3 96), inguinal hernia (13.4%), trauma (13.0%), enlarged tonsil, strabismus, cleft lip & palate, intussusception. The ratio of the congenital to acquired diseases was 39.4% to 60.6 %. 6) Mortality ; 4 cases (0.08%) died during perioperative period.
Age Distribution ; Anesthesia* ; Cleft Lip ; Female ; Hernia, Inguinal ; Humans ; Intubation, Intratracheal ; Intussusception ; Male ; Mortality ; Neurosurgery ; Otolaryngology ; Palate ; Palatine Tonsil ; Perioperative Period ; Retrospective Studies* ; Strabismus ; Surgery, Plastic ; Urology

BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.
Abdominal Pain ; Analgesia ; Analgesia, Patient-Controlled ; Cesarean Section* ; Diclofenac* ; Dizziness ; Female ; Humans ; Incidence ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention

No abstract available.
Pregnancy*

Apert's syndrome is rare autosomal dominant defect characterized by craniosynostosis, midface hypoplasia and symmetrical syndactyly. Multiple surgical procedures will be needed for the child with this syndrome. Especially surgery for craniosynostosis is most often performed between 2 and 6 months of life, a period of physiologic anemia. Perioperative complications can occur from numerous sources-massive blood loss, venous air embolism, cerebral edema, hypothermia and hazardous airway management, thus more monitoring, large bored central venous line and early transfusion are recommended. We report a case of 5 month-old female Apert patient undergoing frontal bone advancement and cranioplasty. At the end of uneventful surgery, we removed endotracheal tube in operating room and permitted early feeding because the procedure was limited above the orbital ridge. As soon as feeding the patient presented cyanosis with generalized seizure. Patient was immediately intubated, sucked out secretions and inhaled with oxygen. Blood gas showed moderate hypoxemia which was improved by oxygen therapy. Suspicious aspiration pneumonia was marked on chest film but disappered I week later. The condition was favorable thereafter and discharged without complication. Keypoints in management of Aperts syndrome are close observation, early detection and preventive treatment of possible complications in perioperative period. (Korean J Anesthesiol 1995; 29: 300~303)
Airway Management ; Anemia ; Anoxia ; Brain Edema ; Child ; Craniosynostoses ; Cyanosis ; Embolism, Air ; Female ; Frontal Bone ; Humans ; Hypothermia ; Infant ; Operating Rooms ; Orbit ; Oxygen ; Perioperative Period ; Pneumonia, Aspiration ; Seizures ; Syndactyly ; Thorax

The fulminant malignant hyperthermia (MH) is now encountered less frequently because of increased awareness of the condition by anesthesiologist and better use of mornitoring facilities. Thus there is also an increase in the number of aborted cases, in which anesthesia is stopped and treatment instituted as soon as MH is thought to be likely. We presented a case of an abortive MH in 18 years old male patient during the discectomy on the third and fourth lumbar intervertebral spaces. Anesthesia was induced with thiopental sodium and succinylcholine and then maintained with nitrous oxide, oxygen and enflurane. After induction, there were persistent tachycardia, elavation of end-tidal CO2 tension on capnography, spontaneous tachypnea, body temperature elevation up to 38.2oC, respiratory acidosis and highly level of CPK, myoglobulin in serum and urine. Under the suspicion of MH, all anesthetics were discontinued and vigorous emergency treatment was attempted including ventilation with high flow of 100% oxygen (8 l/min), changing all anesthetic circuits, and cooling measurements such as chilled intravenous solution infusion, gastric lavage with cold saline, alcohol and ice water pack over the body. Fourtunately, he recovered well and discharged without complications.
Acidosis, Respiratory ; Adolescent ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Body Temperature ; Capnography ; Diskectomy ; Emergency Treatment ; Enflurane ; Fever* ; Gastric Lavage ; Humans ; Ice ; Male ; Malignant Hyperthermia ; Nitrous Oxide ; Oxygen ; Succinylcholine ; Tachycardia ; Tachypnea ; Thiopental ; Ventilation ; Water

BACKGROUND: Propofol is an intravenous anesthetic agent, which has a protective effect on cardiovascular and CNS toxicity of local anesthetics compared with an inhalational agent. Also lipids have a has protective effects on local anesthetic cardiovascular toxicity. So, we had questioned that the protective effect on local anesthetic toxicity comes from the lipid solvent of propofol or propofol itself. METHODS: Eighteen healthy rabbits, weighing 3.0 Kg, were divided into three groups during continuous intravenous infusion of bupivacaine: the control group received normal saline (n = 6), the propofol group received propofol (n = 6), and the intralipid group received intralipid (n = 6). The changes in mean arterial pressure, heart rate and the electrocardiogram were observed during the continuous intravenous infusion of bupivacaine. RESULTS: The onset time of QRS widening and dysrhythmia was significantly prolonged in the propofol group compared with the control and intralipids group. The time required for 25% and 50% decrease in mean arterial pressure and heart rate during bupivacaine infusion was significantly prolonged in experimental groups compared with the control group. In the propofol group compared with the intralipids group, the time required for a 25% and 50% decrease in mean arterial pressure and heart rate were prolonged. CONCLUSIONS: This study suggests that infusion of propofol protection on cardiac toxicity of intravenous infusion by an bupivacaine, the dosage for sedation without cardiovascular adverse effects, is more profound than intarlipids.
Anesthetics, Local ; Arterial Pressure ; Bupivacaine* ; Electrocardiography ; Heart Rate ; Infusions, Intravenous ; Propofol* ; Rabbits*