A 50 year-old woman was scheduled for clipping of giant middle cerebral artery (MCA) aneurysm. Preoperative four-vessel angiography and computed tomography scan revealed a giant aneurysm (3.5x3.3x3.5 cm) at bifurcation of right MCA. Induced hypotension and brain protection using sodium nitroprusside (SNP) and thiopental loading were planned to prevent cerebral damage during the operation. Before induction, esmolol, lidocaine and vecuronium were administered. Mask ventilation with isoflurane in N2O and O2 was performed over 5 minutes and then tracheal intubation was done. Anesthesia was maintained by isoflurane+N2O+O2 with pancuronium. Electrocardiography, pulse oxymetry, capnography, central venous pressure, evoked potential and invasive arterial blood pressure were monitored. She was hyperventilated intraoperatively with a PaCO2 around 30 mmHg. Perioperative hypotension was achieved with infusion of SNP (0.3~1.0 microg/kg/min). During the actual aneurysm surgery, mean arterial pressure was lowered to approximately 50 mmHg. Adjuvant drugs such as methylprednisolone, mannitol and furosemide to reduce intracranial pressure were also administered. This technique established good brain conditions during clipping of the aneurysm. A thiopental loading (4 mg/kg) was supplied while the aneurysm was approached. Satisfactory and well-controlled hypotension was obtained after thiopental and SNP. Postoperatively, the patient was transferred to the intensive care unit.
Anesthesia ; Aneurysm ; Angiography ; Arterial Pressure ; Brain ; Capnography ; Central Venous Pressure ; Electrocardiography ; Evoked Potentials ; Female ; Furosemide ; Humans ; Hypotension ; Intensive Care Units ; Intracranial Aneurysm* ; Intracranial Pressure ; Intubation ; Isoflurane ; Lidocaine ; Mannitol ; Masks ; Methylprednisolone ; Middle Cerebral Artery ; Nitroprusside ; Pancuronium ; Thiopental ; Vecuronium Bromide ; Ventilation

Background: Univent(R) tube was designed to overcome the disadvantages of double lumen endotracheal tube for one lung anesthesia. But overinflation of the blocker cuff of an endobronchial tube can cause pressure damage to the bronchus. The purpose of this study was to evaluate whether the blocker cuff pressure and the duration of ballooning using the Univent(R) tube is correlated with the degree of bronchial mucosal damage (BMD). Methods: A total of 13 men and 7 women intubated with the Univent(R) tube were enrolled for the study. The BMD were evaluated by direct visualization using fiberoptic bronchoscopy prior to intubation and following extubation and the degree of the BMD were scored from 0 to 4 as follows; 0: normal, 1: erythema, 2: swelling, 3: hemorrhage, 4: mucosal wall tearing. Results: No change in bronchial mucosa (score 0) were observed in 11 patients (55%), erythema (score 1) in 5 patients (25%), swelling (score 2) in 3 patients (15%), hemorrhage (score 3) in 1 patient (5%) and mucosal wall tearing (score 4) is none in 20 patients. The bronchial blocker cuff pressure required to "just sealing" the bronchus was 178.1+/-37.4 mmHg with corresponding cuff volume of 6.7+/-1.0 cc. The duration of ballooning was 115.5+/-26.4 min. The correlation coefficient between the blocker cuff pressure and duration of ballooning to the degree of bronchial mucosal damage were 0.125 and 0.137, respectively, which was not statistically significant. Conclusions: The bronchial blocker of Univent(R) tube doesn't cause any severe BMD and the degree of BMD are correlated with neither the bronchial blocker cuff pressure nor duration of ballooning of Univent(R) tube.
Anesthesia ; Bronchi ; Bronchoscopy ; Erythema ; Female ; Hemorrhage ; Humans ; Intubation ; Lung ; Male ; Mucous Membrane

No abstract available.
Animals ; Cryopreservation* ; Embryonic Structures* ; Mice* ; Ovum*

Pseudolipomatosis of the colonic mucosa has been recognized as a lesion featured with aggregations of gaseous spaces in the lamina propria, but its pathogenesis remains still unclear. This paper describes 6 cases of pseudolipomatosis occurring in the mucosa of stomach and large intestine, and the possible factors involved in gastrointestinal endoscopic procedure to produce gaseous entrapment in the lamina propria were analysed. All cases received either gastroscopy or colonoscpy before endoscopic biopsy. Mucosal tissues from both stomach and recto-sigmoid colon revealed multiple aggregations of small air-spaces resembling fatty infiltration in the lamina propria. Rarely were similar infiltrations within the muscularis mucosae and adjacent lymphoid follicles. Evidence for pneumatosis cystoides intestinalis or ulcerative colonic lesion was not associated, although one showed a small gastric ulcer nearby. Repeated inflations and deflations of the stomach or colon during the endoscopic procedure with miner mechanical trauma by instrument to the mucosa seem to contribute to its pathogenesis.

BACKGROUND: The potential adverse effects of ketamine in neurosurgical anesthesia have been well established. However, the effects of ketamine on intracranial pressure (ICP) and hemodynamics during general anesthesia remain unclear. The purpose of this study was to assess the effects of ketamine on hemodynamics and ICP in anesthetized, ventilated rabbits. METHODS: Thirty rabbits were divided into three groups: Group 1 (n=10) received 1 ml/kg normal saline iv; Group 2 (n=10) received 0.5 mg/kg ketamine iv; Group 3 (n=10) received 1.0 mg/kg ketamine iv. After induction with thiopental, anesthesia was maintained with isoflurane and nitrous oxide in oxygen. During controlled ventilation, ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and heart rate (HR) were measured. The ICP was measured using Ladd ICP monitoring system. All variables were evaluated at baseline and for 30 min following ketamine. RESULTS: In group 1, ICP, MAP, CPP and HR were unchanged over the course of the study. In group 2, ICP, MAP and CPP were unchanged. HR increased at 1, 3 and 5 min (p<0.01), 10 and 20 min (p<0.05) after injection. In group 3, ICP, MAP and CPP increased at 1 and 3 min (p<0.01) after injection. HR increased at 1, 3 and 10 min (p<0.01), 5 min (p<0.05) after injection. CONCLUSIONS: These results suggest that 0.5 and 1.0 mg/kg of ketamine don't significantly affect the hemodynamics and ICP in anesthetized, mechanically ventilated rabbits.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Intracranial Pressure* ; Isoflurane ; Ketamine* ; Nitrous Oxide ; Oxygen ; Perfusion ; Rabbits* ; Thiopental ; Ventilation

Some of cerebral palsy patients are accompanied by mental retardation, convulsion, scoliosis and thoracic deformity. We experienced general anesthesia of a 22-year-old male with cerebral palsy accompanied by high degree mental retardation and scoliosis for dental caries therapy. We performed anesthetic management of this patient without any occurrence of anesthesia-related complications, though we had some difficulties in anesthetic induction and postural maintenance during the process. We recognized that considerable attention is needed for the patients with cerebral palsy to avoid undesirable anesthetic complications, especially ventilatory failure and neurologic sequelae.
Anesthesia, Dental ; Anesthesia, General ; Cerebral Palsy* ; Congenital Abnormalities ; Dental Caries ; Humans ; Intellectual Disability ; Male ; Scoliosis ; Seizures ; Young Adult

No abstract available.

Most obviuos will be the several anatomic differences between the proximal femur of the child and the adult. Fractures of the femoral neck in the children are extremely rsre and usually are the result of severe trauma in 80% of the cases. This accounts for the high frequency of serious associated injuries. In this injury the vascular anatomy changing with age, continuing growth potential and the effect of deforming forces play critical roles in high complication rate and these make treatment difficult. But still any secure guidelines for the treatment of this injury are not established and this is a field which requires more active research and further progress in future. 26 cases treated at Paik Hospital from Jan. 1979 to June 1988 were analyzed in clinical and radiological aspect and the following results were obtained. 1. The commonest type was Cervicotrochanteric fracture in 13 cases(50%),displaced one 21 cases. 2. In Transepiphyseal, Transcervical and Cervicotrochanteric fracture by early reduction and internal fixation, and in Intertrochanteric fracture by conservative treatment we gained satisfactory results. 3. We experienced 2 cases of coxa vara in nonthreaded pin used cases, 4 cases of premature epiphseal closure and 4 cases of avascular necrosis in threaded pin used ones. 4. Complications were developed in 13 cases (50%). These were 5 cases of coxa vara(19.2%) 4 cases of premature epiphyseal closure (15.4%) and 4 cases of avascul necrosis (15.4%). 5. Avascykar necrosis was developed in displaced fracture of Transcervical or Cervico- trochanteric fracture beyond postoperative 1 year. So. we recommend periodic long follow up for evaluation of avascular necrosis.
Adult ; Child ; Clinical Study ; Coxa Vara ; Femur ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Necrosis

Perutaneous Transluminal Angioplasty(PTA) is an effective initial treatment modality in renovascularhypertension. For determination of PTA effect, the pulse pressure recording of renal artery is not simple ascompared with in femoral artery stenosis. We tried to evaluate the PTA effect of renal artery stenosis withtracing the pressure of distal renal artery. We used the cardiac catheterization apparatus(VR-12 Honeywell) as apressure monitor in two cases of focal renal arterial stenosis. The renal artery pressure was doubled after firstattempt of ballooning, and the pressure elevated up to 94% and 79% of aorta pressure in two cases, respectively,after third attempt. We believe that renal artery pressure monitoring is a good method of determination of PTAeffect in renovascular hypertension.
Angioplasty ; Aorta ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic ; Femoral Artery ; Hypertension, Renovascular ; Methods ; Renal Artery Obstruction ; Renal Artery

We studied the association of nonspecific bronchial hyperresponsiveness with general characteristics, exposure concentration, respiratory symptoms, chest x-ray findings, past histories and pulmonary function. We determined bronchial hyperresponsiveness by methacholine challenge test. And we conducted a respiratory symptom questionnaire and performed spirometry on 111 workers occupationally exposed to isocyanates in various industries. About 21.6% of subjects had bronchial hyperresponsiveness. No significant differences were observed between the hyperresponsive and non-responsive group with respect to age, sex, employment period, height, and smoking histories cough and breathlessness were significantly associated with the bronchial hyperresponsiveness. The hyperresponsive group had more experience of bronchitis and asthma in the past than the non-responsive group. The lower FEV1 and FEV1 % were closely related with bronchial hyperresponsiveness. Bronchial hyperrespoosiveness seems to be associated with some of respiratory symptoms, past histories and pulmonary function parameters in workers exposed to isocyanates.
Asthma ; Bronchitis ; Cough ; Employment ; Isocyanates* ; Methacholine Chloride ; Occupations ; Surveys and Questionnaires ; Smoke ; Smoking ; Spirometry ; Thorax