Heart transplantation is an accepted procedure for treatment of end-staged cardiac failure. A return to near-normal quality on life can be expected in many patients with a nonrejecting cardiac allograft, and many of these patients will return to the operating room for noncardiac surgical procedures. Anesthesiologists should be alert to recognizing problems caused by the presence of infection in immunosuppressed patients, modes of presentation of rejection phenomena and how transplanted organs, notably significantly denervated ones, may behave and respond under the pathophysiologic circumstance that arise during surgery, resuscitation and intensive care. The use of regional techniques require adequate preloading to avoid exaggerated hypotension and aseptic technique to avoid infection. Hypobaric spinal anesthesia has some benefit. It does not depress cardiovascular and respiratory system and keep adequate venous return by trendelenberg position. We report herein a case of successfully undergone total hip replacement in a patient who had previously undergone orthotopic heart transplantation under hypobaric spinal anesthesia.
Allografts ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Hypotension ; Critical Care ; Operating Rooms ; Respiratory System ; Resuscitation

We describe a technique to clip a large internal carotid artery (ICA) aneurysm via a retrograde suction decompression (RSD). A large aneurysm in the right distal ICA involving the bifurcation region measuring 1.2×1.1×0.7 cm with posterior projection was managed with assisted RSD technique. The anterior choroidal artery emerged from the side wall of the aneurysm. An Inahara shunt was inserted into the ICA with neck dissection, and RSD was applied after completely clipping the aneurysm. RSD with an Inahara carotid shunt is useful for complete visualization of the aneurysm, including its surrounding structures, and for proximal control of the parent vessels, subsequently achieving satisfactory clip placement.
Aneurysm* ; Arteries ; Carotid Arteries ; Carotid Artery, Internal* ; Choroid ; Decompression* ; Humans ; Intracranial Aneurysm ; Neck Dissection ; Parents ; Suction*

While in recent there has been a worldwide decrease in the incidence of convulsion Iron toxemic pregnancy due to improved in the quality and quantity of prenatal care, there has been a relative increase in the proportion of postpartum cases of eclampsia. Postpartum eclampsia accounts for 25% of total eclampsia and occurs most frequently during the first postpartum day. We experienced a case of postpartum eclampsia of immediate onset after cesarean section in a 29 year eld primigravida patient with mild preeclampsia antenataly. She had two convulsive seigure, the first attacH occured juat before the end of anesthesia and the second attacik about 30 minutes after the cesarian section. At that time the patient was treated with thiopental and diazepam intravenously Under the impression of postpartum eclampsia she was given MgSO4, for one day and experienced no other seizures after then. She awakened fully and exhibited no neurological sequeale from the eclampsia. She was discharged from the hospital on the sixth postoperative day with no other complications or sequoia.
Anesthesia ; Cesarean Section* ; Diazepam ; Eclampsia* ; Female ; Humans ; Incidence ; Iron ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy ; Prenatal Care ; Seizures ; Sequoia ; Thiopental

While in recent there has been a worldwide decrease in the incidence of convulsion Iron toxemic pregnancy due to improved in the quality and quantity of prenatal care, there has been a relative increase in the proportion of postpartum cases of eclampsia. Postpartum eclampsia accounts for 25% of total eclampsia and occurs most frequently during the first postpartum day. We experienced a case of postpartum eclampsia of immediate onset after cesarean section in a 29 year eld primigravida patient with mild preeclampsia antenataly. She had two convulsive seigure, the first attacH occured juat before the end of anesthesia and the second attacik about 30 minutes after the cesarian section. At that time the patient was treated with thiopental and diazepam intravenously Under the impression of postpartum eclampsia she was given MgSO4, for one day and experienced no other seizures after then. She awakened fully and exhibited no neurological sequeale from the eclampsia. She was discharged from the hospital on the sixth postoperative day with no other complications or sequoia.
Anesthesia ; Cesarean Section* ; Diazepam ; Eclampsia* ; Female ; Humans ; Incidence ; Iron ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy ; Prenatal Care ; Seizures ; Sequoia ; Thiopental

BACKGROUND: The purpose of this study is to evaluate what kind of crystalloid solution could function as the best buffer and correct the metabolic acidosis most effectively in rabbits with hemorrhagic shock. METHODS: Twenty eight rabbits were bled until mean arterial pressure(MAP) became 70% of control. Thirty minutes after hemorrhagic shock fluid resuscitation was started with either plasmalyte or Hartmann's solution or 0.9% normal saline until MAP returned to 90% of the control. Hemodynamic and blood gas study, plasma lactate and electrolyte concentration were measured before, during, and 30 minutes after recovery from shock. RESULTS: The amount of shed blood to reduce MAP to 70% of control ranged 76~87 ml. And the volume for fluid resuscitation was 274~324 ml. There was no statistically significant difference among the three groups. The pH decreased during shock in all group and still decreased after resuscitation in Hartmann's solution and normal saline. But it increased significantly after resuscitation in plasmalyte. Lactate was increased in all group during shock and decreased by 22 and 23 mg/dl after resuscitation in plasmalyte and normal saline. But it still increased by 40 mg/dl in Hartmann's solution. Serum potassium level decreased significantly after resuscitation with normal saline. Serum calcium level decreased significantly after resuscitation with plasmalyte and normal saline. CONCLUSION: With the above results the plasmalyte which has pH closer to that of normal blood might be able to avoid the metabolic acidosis and maintain acid-base equilibrium effectively after fluid resuscitation in acute hemorrhagic shock.
Acid-Base Equilibrium ; Acidosis ; Calcium ; Hemodynamics ; Hydrogen-Ion Concentration ; Lactic Acid ; Plasma ; Potassium ; Rabbits* ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

BACKGROUND: Baroreceptor reflex responds to the decrease in blood pressure caused by drug, dehydration, or severe bleeding. Vagal reflex caused by direct pressure on vagus nerve, the traction, or lung inflation develops bradycardia and severe arrhythmia. Lung inflation elicits a vasodepressor reflex, resulting in stimulation of the vagus nerve which causes a decrease in sympathetic outflow. METHODS: 75 patients who had elective surgery were divided into 3 groups according to the age, such as group I: < or =15 years of age, group II: 16-64 years of age, group III: > or = 65 years of age. Lung inflation test has been performed at 20 cmH2O for 20 seconds. Baroreceptor was stimulated by lowering blood pressure with intravenous infusions of nitroglycerin. Baroreceptor sensitivity was assessed by measuring the decrease in blood pressure. Vagal reflex sensitivity was calculated by the subtraction of G2 (baroreceptor reflex sensitivity after introglycerin infusion) from G1 (heart rate response to lung inflation). RESULTS: Baroreceptor reflex induced by hypotension and vagal reflex originated from lung influe-nced the heart rate inversely when lung inflated. Baroreceptor reflex sensitivity was highest in younger patients and lowest in older patients when nitroglycerin infused. Vagal reflex sensitivity was highest in older patients and lowest in younger patients. CONCLUSIONS: Baroreceptor reflex was most sensitive in younger patients, but vagal reflex was moresensitive in older patients.
Anesthesia, General* ; Arrhythmias, Cardiac ; Baroreflex* ; Blood Pressure ; Bradycardia ; Dehydration ; Enflurane* ; Heart Rate ; Hemorrhage ; Humans ; Hypotension ; Inflation, Economic ; Infusions, Intravenous ; Lung ; Nitroglycerin ; Pressoreceptors* ; Reflex* ; Traction ; Vagus Nerve

Nutcracker syndrome consists in the compression of the left renal vein by an aortomesenteric clamp. This results in left renal venous hypertension leading to the development of collateral veins with intrarenal and perirenal varicosities which can cause hematuria. The main presenting symptom is hematuria with or without left flank pain. It responds successfully to surgical treatment. We report a case of anesthesia for a nutcracker syndrome patient.
Anesthesia ; Flank Pain ; Hematuria ; Humans ; Hypertension ; Renal Veins ; Veins

BACKGROUND: Bag and mask devices are used frequently to provide patients with positive-pressure-assisted ventilation. One of the disadvantages is the fact that they do not deliver high concentrations of oxygen without special adaptors or attention to technique. In order to investigate the variables affecting oxygen delivery, we designed a study to determine the fractions of delivered oxygen (FDO2) under varying ventilating techniques and conditions. METHODS: We designed special wooden box, in which the Laerdal resuscitator bag had been. We measured the fractions of delivered oxygen with or without reservoir bag in various tidal volumes, respiration rates and oxygen flows. RESULTS: Without reservoir bag, the fractions of delivered oxygen were increased up to only 73% in spite of 15 l/min oxygen flow. With reservoir bag, the fractions of delivered oxygen were increased up to nearly 96% in 5-7.5 l/min oxygen flow. CONCLUSIONS: While using the Laerdal resuscitator bag, it is desirable to adapt reservoir bag and supply 5 l/min oxygen in conventional ventilation and 7.5 l/min in hyperventilation minimally for higher fraction of delivered oxygen.
Humans ; Hyperventilation ; Masks ; Oxygen* ; Respiratory Rate ; Tidal Volume ; Ventilation

BACKGROUND: Laparoscopic and pelviscopic techniques have rapidly increased in recent years. Laparoscopy or pelviscopy require carbon dioxide (CO2) insufflation and Trendelenburg or reverse-Trendelenburg position for operational convenience. Many studies were done about the effects of laparoscopic procedures. But simultaneous comparisons of end-tidal CO2 tension (PETCO2), peak airway pressure (Ppeak), plateau pressure (Pplat) and respiratory compliance (Cdyn), between Trendelenburg and reverse-Trendelenburg position are rare. We compared the airway pressure and compliance between the two positions during laparoscopic surgery. METHOD: Eighty patients were divided into 2 groups: for 10o reverse-Trendelenburg position (n=40, Group R) and 10o Trendelenburg position (n=40, Group T). Abdominal pressure was maintained at 10 mmHg by a CO2 insufflator, and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. We observed the change of PETCO2, Ppeak, Pplat, and Cdyn at 1 minutes before CO2 insufflation (control value), 2 min after position change, 5, 20, 30, 60 minutes after CO2 insufflation, 2 min after CO2 removal, and 2 min after operation. RESULT: PETCO2, Ppeak, and Pplat were increased and Cdyn was decreased significantly after pneumoperitoneum compared with the control in group R. PETCO2, Ppeak, and Pplat were increased significantly under the Trendelenburg compared with the reverse-Trendelenburg, and Cdyn was decreased significantly in Trendelenburg compared with reverse-Trendelenburg. CONCLUSION: PETCO2, Ppeak, Pplat, and Cdyn impedances increased more under the Trendelenburg after pneumoperitoneum compared with reverse-Trendelenburg. We should pay more attention to patient with pulmonary disease, obesity, and old age under the Trendelenburg than reverse-Trendelenburg position.
Carbon Dioxide ; Compliance* ; Head-Down Tilt ; Humans ; Insufflation* ; Laparoscopy* ; Lung Diseases ; Obesity ; Pneumoperitoneum ; Respiratory Rate ; Tidal Volume ; Ventilation

The relationship between the adequate endotracheal tube size, depth of tube fixation and incisor canina distance according to age(month) and body weight(kilogram) was studied in 148 infants. Intubation was proceeded by injection of thiopental sodium 4mg/kg and succinylcholine 1.5mg/kg in infants older than two months, whereas conscious intubation was used for infants less than two months of age. The relation coefficiency between tube size and body weight(0.83) was greater than that of age(0.76). The relation coefficiency between the depth of tube fixation and body weight(0.83) was greater than that of age(0.75) or tube size(0.77). The relation coefficiency between incisor carina distance and body weight(0.87) was greater than that of age(0.78) or tube size(0.80). Endobroncheal intubation was tried intentionally to evaluate the incidence of left broncheal intubation. Only one infant among 148 exhibited left broncheal intubation. This baby was full term, weighed 2.6kg with gastroschisis. With the above results we assume that body weight is the most important determinant factor for adequate tube size, depth of tube fixation and incisor carina distance. Attention should be paied to unintentional left broncheal intubation in infants less than one month old especially in low birth weight babies.
Body Weight ; Gastroschisis ; Humans ; Incidence ; Incisor ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Intention ; Intubation ; Intubation, Intratracheal* ; Succinylcholine ; Thiopental