BACKGROUND: The apnea test is an essential component in the clinical determination of brain death, however it may incur a significant risk of complications such as hypotension, hypoxia and even cardiac arrest. We analyzed the risk factors associated with a failed apnea test during brain death assessment in order to predict and avoid these adverse events. METHODS: Medical records on apnea tests performed for brain-dead donors at our institution between January 2009 and January 2016 were retrospectively reviewed. Age, gender, etiology of brain death, use of catecholamines and results of arterial blood gas analysis (ABGA), systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure and central venous pressure prior to apnea test initiation were collected as variables. A-a gradient and P(aO2)/F(iO2) were calculated for more precise assessment of the respiratory system. In total, 267 cases were divided into two groups based on those who completed the apnea test and those who failed the test. RESULTS: 13 cases failed the apnea test. Among them, seven cases failed due to severe hypotension (SBP < 60 mmHg) and the others failed due to refractory hypoxia. In terms of hemodynamic state, SBP was significantly higher in the completed test group than the failed group (126.5 ± 23.9 vs. 103 ± 15.2, respectively; p = 0.001). In ABGA, the completed test group showed significantly higher P(aO2)/F(iO2) (313.6 ± 229.8 vs. 141.5 ± 131.0, respectively; p = 0.008) and a lower A-a gradient (278.2 ± 209.5 vs. 506.2 ± 173.1, respectively; p = 0.000). In multivariable analysis, low SBP (p = 0.003) and high A-a gradient (p = 0.044) were independent risk factors associated with a failed apnea test. CONCLUSIONS: Although the unexpected adverse events during the apnea test for brain death determination do not occur frequently, they can be fatal. If a brain-dead patient has low SBP and a high A-a gradient, clinicians should pay more attention and prepare for potential complications prior to the apnea test.
Anoxia ; Apnea* ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Brain Death* ; Brain* ; Catecholamines ; Causality ; Central Venous Pressure ; Heart Arrest ; Hemodynamics* ; Humans ; Hypotension ; Medical Records ; Respiratory System ; Retrospective Studies ; Risk Factors ; Tissue Donors

Epidural hematoma associated with epidural anesthesia is rare. We describe a case of a epidural hematoma after continuous epidural anesthesia and analgesia for arthroscopic patella shaving. Anesthesia was indudced with 8 ml lidocaine, 2.0% with epinephrine, 1:200,000 and surgery proceeded. When additional boluses of bupivacaine were administered later, aspiration of the epidural catheter still yielded no blood. At the end of the operation, an epidural infusion of 0.125% bupivacaine was done 2 ml/hr by two-day infusor. In the third postoperative day, the patient suffered from acute myocardial infarction and then heparin was infused. In the fourth postoperative day, she complained lumbar back pain and developed depressed dorsiflexion (Grade II) of great toe in left foot during the infusion of heparin. Sagittal MRI showed posterior thickened epidural hematoma along the segments of T12-L4. Despite the delayed laminectomy and decompression, which was performed six days after her initial operation, she had a good postoperative response, followed by a complete neurological recovery.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Back Pain ; Bupivacaine ; Catheters ; Decompression ; Epinephrine ; Foot ; Hematoma* ; Heparin ; Humans ; Infusion Pumps ; Laminectomy ; Lidocaine ; Magnetic Resonance Imaging ; Myocardial Infarction ; Patella ; Toes

No abstract available.
Calculi* ; Lithotripsy* ; Shock*

No abstract available.
Evaluation Studies as Topic* ; Hoarseness*

The effects of BCG and vitamin A acetate, either alone or in combination were studied on rats with bladder tumors induced by N-butyl -N-(4 -hydroxybutyl) nitrosamine. Therapy was started at week 12 and all rats were sacrificed at week 20. Vitamin A acetate therapy significantly reduced the mean number of tumors and the incidence of bladder cancer. The combination of vitamin A acetate and intraperitoneal BCG therapy, more effectively reduced the mean number of bladder tumors and the incidence of bladder cancer than vitamin A acetate therapy alone did. BCG therapy also significantly reduced the mean number of tumors and the incidence of bladder cancer. The difference between the effect of intraperitoneal BCG injection and that of intravesical BCG was not statistically significant. The combination therapy of BCG and vitamin A acetate more effectively reduced the mean number or tumors than BCG therapy along did. The incidence of bladder cancer was also reduced though the statistical significance was not definite (p =0.07). The above results suggest that vitamin A acetate and BCG therapy after initiation of precancerous lesions, alter favorably the course of the experimental bladder cancers in rats and the combination of the two does more effectively.
Animals ; Bacillus* ; Incidence ; Mycobacterium bovis ; Rats ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Vitamin A* ; Vitamins*

No abstract available.
Aged* ; Humans ; Hypertension* ; Self Care*

Recently it has been stated that animals without ischemic arrhythmia would be at almost no risk for reperfusion ventricular fibrillation(VF) in contrast to animals with ischemic arrhythmias. In order to observe the differences of ararrhythmias characteristics between ischemic and reperfusion period, and correlationship between occlusion and reperfusion arrhythmias, the left anterior descending(LAD) coronary artery was occluded for 20 minutes and reperfused for 10 minutes in 24 anesthetized cats. The results were as follows; 1) After ligation of LAD coronary artery, the R wave, S-T segment and T wave of epicardial EKG were elevated to reach maximum level at 5-10 minutes. 2) During reperfusion, the changes of R wave, S-T segment, and T wave of epicardial EKG were not significant. 3) The incidence of arrhythmias at early phase and late phase of occlusion period were 41.6% and 100% respectively. The ischemic arrhythmia score was 2.38+/-1.61 and incidence of ventricular tachycardia(VT) was 66% 4) The incidence of VT and VF during reperfusion was 100% and 62.5% respectively. The reperfusion arrhythmia score was 5.88+/-1.72. 5) The two morphologies of ventricular arrhythmias were observed at occluson and reperfusion period. 6) The disparities between occlusion and reperfusion arrhythmias were observed. 7) The cats with shorter R-R internal and/or lower systolic left ventricualr pressure had the higher incidence of VF. In summary, although the morphology of occlusion ventricular arrhythmias was similar to that of reperfusion ventricular arrhythmias, the lack of correlation between reperfusion VF and ischemic arrhythmias was observed. So we suggest that further studies which provide the different mechanisms involved in occlusion and reperfusion arrhythmias were needed.
Animals ; Arrhythmias, Cardiac* ; Cats* ; Coronary Vessels ; Electrocardiography ; Incidence ; Ligation ; Reperfusion*

No abstract available.
Calcium Carbonate* ; Calcium* ; Humans ; Renal Dialysis*

No abstract available.
Animals ; Cystitis* ; Estrogens* ; Rats* ; Urinary Bladder*

To a patient suffering from intractable pain due to the terminal state of cervix cancer, 7% phenol-glycerine solution was injected through the L2-L3 interspace. We obtained a good result of pain relief, but motor paralysis developed.
Humans ; Pain, Intractable ; Paralysis ; Uterine Cervical Neoplasms