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Atrial Fibrillation Developed after Induction of General Anesthesia in an Elderly Patient: A case report.

The Korean Journal of Critical Care Medicine.1998;13(2):261-261.

It is known that the incidence of arrhythmia related to anesthesia and operation is significantly higher in thoracic surgery such as cardiac, lung operation than any other operation, and atrial fibrillation is the most common arrhythmia among these arrhythmias. Besides operative sites, age and underlying cardiac problem such as hypertension, cardiomegaly can be important risk factors for intra, post-operative atrial fibrillation in non-thoracic surgery. Through many investigations, we can find that age is the most important because age related anatomical, physiological cardiac changes make elderly patients more susceptible to development of atrial fibrillation. In this case, we report atrial fibrillation that occurred after induction of general anesthesia in an elderly patient undergoing open reduction of upper arm fracture.
Aged* ; Anesthesia ; Anesthesia, General* ; Arm ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Cardiomegaly ; Humans ; Hypertension ; Incidence ; Lung ; Risk Factors ; Thoracic Surgery

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Successful Coronary Interventions with the Aid of Abciximab (ReoPro (R)) in High-Risk Patients: Report of Two Cases.

Woo Suck PARK ; Myung Ho JEONG ; Nam Ho KIM ; Young Keun AHN ; Youl BAE ; Gwang Chae GILL ; Joo Hyung PARK ; Jeong Gwan CHO ; Jong Chun PARK ; Jung Chaee KANG

The Korean Journal of Critical Care Medicine.1998;13(2):254-260.

Abrupt closure of coronary artery during coronary intervention is one of major limitations especially in high-risk patients. Platelets are responsible for composing acute thrombotic occlusion at the site of therapeutic arterial injury. Abciximab (platelet glycoprotein IIb/IIIa receptor blocker) might be helpful in preventing the acute thrombotic occlusion. We experienced an excellent effects of the drug in two cases of high-risk patients, unsuccessful thrombolytics and PTCA with acute occlusion. With additional use of abciximab we overcame the complications and succeeded in getting normal coronary flow and resultant successful angioplasties.
Angioplasty ; Coronary Vessels ; Glycoproteins ; Humans

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Management of Post-transplant Lung Recipients.

Sook Whan SONG

The Korean Journal of Critical Care Medicine.2001;16(1):1-4.

No abstract available.
Lung*

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Effect of Endotoxin on Cerebrospinal Fluid Formation in the Rat.

Dong Chan KIM ; Yu Jeong KIM ; Gi Chul MIN

The Korean Journal of Critical Care Medicine.2001;16(1):48-54.

BACKGROUND: Bacterial lipopolysaccharide (LPS), an endotoxin, can increase nitric oxide (NO) production by expression of an inducible isoforms of nitric oxide synthase (iNOS). Bacterial infections of the central nervous system dilate cerebral vessels and increase cerebral blood flow. We hypothesized that systemic and intraventricular application of bacterial lipopolysaccharide would increase cerebrospinal fluid (CSF) production due to increase in blood flow to choroid plexus caused by NO-induced vasodilation. METHODS: Ventriculocisternal perfusion was used to measure the production of CSF in pentobarbital-anesthetized rats. The lateral ventricle and cisterna magna were cannulated stereotactically and perfused continuously with artificial CSF with blue dextran 2000 as the indicator. Baseline collections of CSF began after steady state outflow was established; then, endotoxin was administered intravenously or intraventricularly. The baseline rate of CSF production was compared with that measured during 3 hours after endotoxin administration. RESULTS: The baseline rate of CSF production was 2.6 0.3 (2.2~3.5)microliter/minute in the rat. There were no significant changes in CSF production rate after intravenous or intraventriculr administration of endotoxin. CONCLUSIONS: We could not observe significant changes in CSF production rate with the ventriculocisternal perfusion method of measuring CSF production after intravenous or intraventriculr administration of endotoxin in the rats.
Animals ; Bacterial Infections ; Central Nervous System ; Cerebrospinal Fluid* ; Choroid Plexus ; Cisterna Magna ; Dextrans ; Lateral Ventricles ; Nitric Oxide ; Nitric Oxide Synthase ; Perfusion ; Protein Isoforms ; Rats* ; Vasodilation

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Evaluation of the Efficacy of the Flexiblade Laryngoscope in Endotracheal Intubation.

Sun Young JANG ; Sang Kyi LEE

The Korean Journal of Critical Care Medicine.2001;16(1):42-47.

BACKGROUND: A new laryngoscope, Flexiblade has flexible adjustable rigid blade. The Flexiblade is composed of a handle and a blade with an adjunct trigger. Squeezing the trigger changes the blade curvature from nearly a straight Miller blade into a curved Macintosh blade. This study was designed to evaluate the clinical application of the Flexiblade laryngoscope in endotracheal intubation for adult patients. METHODS: Following the induction of general anesthesia and muscle paralysis, the laryngoscopic views of 50 patients were measured while five different blade positions in the oral cavity were performed. The laryngoscopic view which was described by Cormack and Lehane was classified from grade 1 to grade 4 except one blade position. Adjusting maneuvers such as laryngeal lift and/or a styletted intubation were used to facilitate a tracheal intubation. Complications which were directly related to the Flexiblade laryngoscope were also evaluated. RESULTS: In use of the Flexiblade laryngoscope just like straight Miller blade, the vocal cord (< or =grade 2) were exposured in 82% of the patients. The 96% of patients showed a good vocal cord exposure (< or =grade 2) with a partial depression of the triggers of the laryngoscope. Overall rate of a successful intubation was 98%. In partial depression of trigger of the Flexiblade laryngoscope compared with neutral position, 22 patients of 26 patients with laryngoscopic view of grade 2 were improved by one grade, and 15 patients of the 17 patients with laryngoscopic view of grade 3 were improved by more than one grade. CONCLUSIONS: The Flexiblade laryngoscope is useful for endotracheal intubation for adult patients.
Adult ; Anesthesia, General ; Depression ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopes* ; Mouth ; Paralysis ; Vocal Cords

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Bone Marrow Transplantation.

Woo Sung MIN

The Korean Journal of Critical Care Medicine.2001;16(1):17-22.

No abstract available.
Bone Marrow Transplantation* ; Bone Marrow*

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The Effect of Low-dose Dopamine on Splanchnic and Renal Blood Flow in Patients with Septic Shock under the Treatment of Norepinephrine.

Jong Joon AHN ; Tae Hyung KIM ; Ki Man LEE ; Tae Sun SHIM ; Chae Man LIM ; Sang Do LEE ; Woo Sung KIM ; Dong Soon KIM ; Won Dong KIM ; Younsuck KOH

The Korean Journal of Critical Care Medicine.2001;16(1):36-41.

BACKGROUND: Norepinephrine, which is frequently administered as a vasopressor to the patients with septic shock, can decrease splanchnic and renal blood flows and aggravate splanchnic and renal ischemia. The low-dose dopamine (LDD) has been frequently combined with norepinephrine to ameliorate renal and splanchnic hypoperfusion in patients with septic shock. However, the effect of the LDD on the splanchnic and renal blood flow has not been fully elucidated. This investigation was carried out to determine the effect of the LDD on the splanchnic and renal blood flow in the patients with septic shock under the treatment of norepinephrine. METHODS: Eleven patients with septic shock were included in this study. All of them were under the norepinephrine treatment as the mean arterial pressure (MAP) was less than 70 mm Hg in spite of the adequate fluid resuscitation. With stabilization of MAP, the LDD (2 g/kg/min) was administered for two hours in each patients. Hemodynamics, gastric intramucosal pH (pHi), gastric regional PCO2 (rPCO2), rPCO2 - PaCO2, urine volume, urine sodium excretion and creatinine clearance were compared between with and without the LDD infusion. Diuretics was not used during the study period. RESULTS: Age of patients (n=11) was 64 12 and the APACHE III score was 84 17. The mortality rate of the subjects was 64%. Dosage of norepinephrine was 0.55 0.63 g/kg/min during the study period. There were no significant differences in hemodynamics (central venous pressure, cardiac output, pulmonary artery occlusion pressure, mixed venous gas), pHi, rPCO2, rPCO2 - PaCO2 depending on the concomitant infusion of the LDD. The volume of urine tended to increase (P=0.074) after concomitant LDD, but the changes in urine sodium excretion and creatinine clearance were not significantly different. CONCLUSIONS: The combined infusion of the LDD with norepinephrine did not improve splanchnic and renal blood flow in the patients with septic shock.
APACHE ; Arterial Pressure ; Cardiac Output ; Creatinine ; Diuretics ; Dopamine* ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Mortality ; Norepinephrine* ; Pulmonary Artery ; Renal Circulation* ; Resuscitation ; Shock, Septic* ; Sodium ; Venous Pressure

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Perioperative Intensive Care for Liver Transplantation.

Shin HWANG ; Dong Lak CHOI ; Cheol Soo AHN ; Dong Eun PARK ; Sun Hyung JOO ; Jang Yong JEON ; Kyeong Mo KIM ; Yang Won NAH ; Kwang Min PARK ; Young Joo LEE ; Sung Gyu LEE

The Korean Journal of Critical Care Medicine.2001;16(1):5-10.

Many liver recipients have required intensive care, which is individualized and customized to each recipient. Prerequisites qualifying this care are wide comprehension of characteristics of end-stage liver disease and mechanisms of surgical procedures and immunologic knowledge. We present our principles of intensive care and experience from more than 300 cases of liver transplantation. There are roughly two types of liver transplantation, cadaveric and living-donor. These two types are different in their postoperative courses as following; severity of preservation injury, graft-size matching and morphologic liver regeneration and risk of vascular and biliary complications. Intensive care for liver recipients should be directed toward preventive and protective care along reasonable prediction of its clinical course. We described our experience about following subjects: management of hepatorenal syndrome, fulminant hepatic failure, acute renal failure, pneumonia, disturbance of consciousness, prophylaxis of viral hepatitis B, tumor recurrence, use of antibiotics, induction of liver function recovery, maintenance of vital signs, electrolyte balance, diet and infection control, nutritional support. The most important factor is the state of transplanted liver graft in determination of posttransplant course. If the graft functions well, many problems will be solved spontaneously. If not, intensive care will be required. Most of operative complications are related to the surgery itself, so that comprehension to surgical procedures to each recipient should be preceded for early detection and proper management. To achieve a favorable posttransplant course, all factors including maintenance of vital signs, elimination of obstacles to hepatic recovery, appropriate immunosuppression and solution of surgical complications should be met altogether. Of course, every member of liver transplantation team should pay durable attention and dedication to each liver recipient.
Acute Kidney Injury ; Anti-Bacterial Agents ; Cadaver ; Comprehension ; Consciousness ; Diet ; Fibrinogen ; Hepatitis B ; Hepatorenal Syndrome ; Immunosuppression ; Infection Control ; Critical Care* ; Liver Diseases ; Liver Failure, Acute ; Liver Regeneration ; Liver Transplantation* ; Liver* ; Nutritional Support ; Pneumonia ; Recovery of Function ; Recurrence ; Transplants ; Vital Signs ; Water-Electrolyte Balance

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Changes of Heart Rate, Blood Pressure, and Plasma Catecholamine Levels in Rabbits during the Apneic Oxygenation.

Seung Eun OH ; Hyun Jeong KIM ; Kwang Won YUM

The Korean Journal of Critical Care Medicine.2001;16(1):30-35.

BACKGROUND: Permissive hypercapnia and apneic oxygenation are used to provide oxygen to patient without active ventilation. It is well known that hypercapnia induces the release of endogenous catecholamines. However, it is unclear that how much or what kind of catecholamines are released. The aim of this study was to observe changes of basic hemodynamic parameters and plasma catecholamine concentration during apneic oxygenation. METHODS: Twenty-one rabbits weighing 2.0~3.0 kg were anesthetized with 100% oxygen and isoflurane. 0.05 mg/kg of atropine was injected and endotracheal intubation was done. 1 mg/kg/hr of vecuronium was infused during the experiment. The anesthesia and apneic oxygenation was maintained with 100% oxygen and 2 vol% isoflurane under 1 cmH2O PEEP using continuous positive airway pressure device. During the apneic oxygenation, blood pressure, heart rate, and plasma catecholamine concentration were measured every 10 min using High Performance Liquid Chromatography. RESULTS: Systolic blood pressure was significantly increased but diastolic blood pressure was not changed until post-apneic 40 min. After then, both systolic and diastolic blood pressure were significantly decreased. At post-apneic 10 min, heart rate was dramatically decreased and slowly recovered to the level of control data until post-apneic 60 min. Plasma epinephrine level was increased higher than that of norepinephrine by 3 to 4 times. CONCLUSIONS: Epinephrine may play more important role than norepinephrine to compensate the cardiovascular depressive effects of hypercapnia during the apneic oxygenation in rabbits.
Anesthesia ; Atropine ; Blood Pressure* ; Catecholamines ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Continuous Positive Airway Pressure ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypercapnia ; Intubation, Intratracheal ; Isoflurane ; Norepinephrine ; Oxygen* ; Plasma* ; Rabbits* ; Vecuronium Bromide ; Ventilation

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Heart Transplantation. A Retrospective Analysis of the Short and Intermediate Term Results.

Suk Jung CHOO ; Jung Hun OH ; Jae Joong KIM ; Meong Gun SONG

The Korean Journal of Critical Care Medicine.2001;16(1):23-29.

BACKGROUND: Heart transplantation is still the best therapy for end-stage heart disease. However, the longterm outcome among different institutions vary. The current series is an assessment of the important factors which determine prognosis. METHODS: Between November of 1992 and September of 2000, 85 heart transplantations were performed at our institution. The standard technique was used in the first 57 patients (group I) where as in the latter 28 patients (group II), the Bicaval technique was utilized. The mean waiting time was approximately 4.7 months, and the causes in decreasing order were Dilated cardiomyopathy (n=69), Ischemic cardiomyopathy (n=10), Hypertrophic cardiomyopathy and others (n=6). The mean follow up was about 31 months. The immunosuppressive protocol comprised cyclosporin, Azathioprine (AZA), and prednisone. Later changes included induction with IL-2 receptor monoclonal antibody and changing AZA to mycophenolate mofetil. RESULTS: The mean donor ischemic time was 95.8 28.3 mins and the implantation time was 59.3 7.6 mins. There was a higher incidence of significant TR in group I along with a greater postoperative pacing requirement. There were 35 postoperative complications of which infectious events were most common (26). Of these, only 3 were early infections and the rest occurred late postoperatively. There were a total of 8 mortalities of which only one occurred early postoperatively and among the 7 late deaths, 3 were medically related and 4 were related to social factors. Only 5% of the patients had graft vascular disease. The overall 1YSR was 92% and the 5 YSR was 85%. CONCLUSIONS: The superior long term results of this current series was attributable to strong early immunosuppression, a homogenous population, and very low incidence of CMV infection.
Azathioprine ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Cyclosporine ; Follow-Up Studies ; Heart Diseases ; Heart Transplantation* ; Heart* ; Humans ; Immunosuppression ; Incidence ; Mortality ; Postoperative Complications ; Prednisone ; Prognosis ; Receptors, Interleukin-2 ; Retrospective Studies* ; Tissue Donors ; Transplants ; Vascular Diseases

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