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J-guide Wire Knotting during the Central Venous Catheterization: A case report.

Korean Journal of Anesthesiology.2003;44(5):725-728. doi:10.4097/kjae.2003.44.5.725

The purposes of central venous catheterization (CVC) are as followings, central venous pressure monitoring, pulmonary artery catheterization and monitoring, transvenous cardiac pacing, temporary hemodialysis, drug administration, rapid infusion of fluids, aspiration of air embolism. Various complications may occur during CVC, such as hematoma, pneumothorax, hemothorax, hydrothorax, chylothorax, nerve and artery injury, air embolism, thromboembolism, arrhythmia, heart block, cardiac tamponade, and tracheal puncture. In Korea, several complications have been reported after CVC, such as pneumothorax, hemothorax, hemomediastinum, cardiac tamponade and tracheal puncture. However, there has been no report about the knotting of J-guide wire during the CVC. We report a case of J-guide wire knotting during central venous catheterization.
Arrhythmias, Cardiac ; Arteries ; Cardiac Tamponade ; Catheterization, Central Venous* ; Catheterization, Swan-Ganz ; Central Venous Catheters* ; Central Venous Pressure ; Chylothorax ; Embolism, Air ; Heart Block ; Hematoma ; Hemothorax ; Hydrothorax ; Korea ; Pneumothorax ; Punctures ; Renal Dialysis ; Thromboembolism

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Intradiscal Electrothermal Annuloplasty in Chronic Discogenic Low Back Pain.

Wan Soo OH ; Ho Jeong KANG ; Kwang Min KIM

Korean Journal of Anesthesiology.2001;40(4):551-556. doi:10.4097/kjae.2001.40.4.551

Chronic discogenic low back pain remains a difficult treatment challenge. Also, Internal disc derangement in the lumbar spine is a common yet difficult clinical condition to treat. The reported prevalence of chronic low back pain due to intrinsic disc mediated pain is at least 40%. Internal disc derangement has characteristics such as degeneration of the collagen of the disc annulus, fissures, global disc degeneration, and herniation with or without root compression. The common treatment for chronic discogenic low back pain has been conservative, including physical therapy and pharmacological management but the effectiveness remians controversial. Surgical fusion offers modest results at best, but often fails, and is associated with complications and postoperative continued pain. The intradiscal electrothermal annuloplasty has become known as a safe and effective treatment for patients suffering from discogenic pain and offers the advantage of potentially repairing the damaged disc while maintaining normal disc function. We applied a navigable catheter with a temperature controlled thermal resistive coil, deployed intradiscally through a percutaneous extrapedicular approach under two plane fluoroscopic guidance in chronic low back patients. The authors experienced two cases of chronic discogenic pain that had failed to respond to any kind of conservative treatment but which was successfully relieved by the intradiscal electrothermal annuloplasty.
Catheters ; Collagen ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain* ; Prevalence ; Spine

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Pneumothorax and Pneumomediastinum Occurred after Esophageal Perforation by a Stylet during Difficult Endotracheal Intubation.

Yee Suk KIM ; In Su HAN ; June Kyu AHN

Korean Journal of Anesthesiology.2001;40(4):546-550. doi:10.4097/kjae.2001.40.4.546

Pneumothorax and pneumomediastinum can occur spontaneously, secondary to trauma, or from dissection of air from the neck or retroperitoneal space. The most common cause of traumatic pneumomediastinum is a rupture of the esophagus, which can occur during an episode of severe vomiting or, less frequently, following esophageal instrumention. We experienced a case of pneumothorax and pneumomediastinum, developed after esophageal perforation by stylet during difficult endotracheal intubation even though an esophagogram did not reveal the perforation site.
Esophageal Perforation* ; Esophagus ; Intubation, Intratracheal* ; Mediastinal Emphysema* ; Neck ; Pneumothorax* ; Retroperitoneal Space ; Rupture ; Vomiting

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Fracture of Laryngeal Mask Airway during General Anesthesia.

Shi Ne YOON ; Hong Seuk YANG

Korean Journal of Anesthesiology.2001;40(4):543-545. doi:10.4097/kjae.2001.40.4.543

Laryngeal mask airway (LMA) is an adjunctive airway device composed of a tube with a cuffed mask-like projection on the distal end, which is more practical than a face mask and less invasive than an endotracheal tube. It has the great economical advantage of being reusuable. Even though the LMA withstands a large number of sterilization cycles without undergoing damage, these sterilization cycles make the tear strength of the LMA lower. And it can be easily damaged during anesthesia or sterilization. We report a case of a fracture of the LMA during anesthesia probably caused by teeth as well as prolonged and repeated use.
Anesthesia ; Anesthesia, General* ; Laryngeal Masks* ; Masks ; Sterilization ; Tooth

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Malposition of a Subclavian Catheter in the Internal Jugular Vein Due to the Direction of a J-type Guidewire End .

Young Tae JEON ; Yong Seok OH ; Jae Hyon BAHK

Korean Journal of Anesthesiology.2001;40(4):539-542. doi:10.4097/kjae.2001.40.4.539

A central venous catheter is inserted through the subclavian vein for the purpose of administration of fluids and drugs, and the monitoring of the central venous pressure. Central venous catheterization is associated with complications that may occur during the insertion of the catheter or owing to the aberrant location of its tip. A malpositioned catheter can result in faulty central venous pressure reading or lead to thrombosis of the vein. Many attempts have been made to correctly place a central venous catheter into the superior vena cava. We report a case where the cephalad direction of the flexible end of a J type guidewire was related to the guidewire advancing into the internal jugular vein.
Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Central Venous Pressure ; Jugular Veins* ; Subclavian Vein ; Thrombosis ; Veins ; Vena Cava, Superior

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Evaluation of Presynaptic Action of Depolarizing Neuromuscular Blocking Agents with Single Twitch Response in Vitro.

Kyung Ho HWANG ; Won Seok CHAI ; Kyu Sik KANG ; Yong Ik KIM ; Wook PARK ; Sung Yell KIM

Korean Journal of Anesthesiology.2001;40(4):532-537. doi:10.4097/kjae.2001.40.4.532

BACKGROUND: This study was performed to evaluate the presynaptic effects of depolarizing neuromuscular blocking drugs by using slow and fast frequencies of indirect stimulation on partial twitch depression in vitro. METHODS: A rat phrenic nerve hemidiaphragm was dissected and was mounted in an organ bath containing an oxygenated Krebs solution. The phrenic nerve was stimulated supramaximally and the twitch response (0.1 Hz) was stabilized for at least 30 minutes. T200/T1 ratio (twitch height of the 200th stimuli divided by that of the first stimuli) at frequencies of 0.2, 0.5, 1.0, and 2.0 Hz using a drug concentration which provided approximately 20% twitch depression at 0.1 Hz was calculated. To compare T200/T1 ratios with TOF ratios, a 2.0 Hz TOF response was measured immediately after the 200th stimuli at either frequency of stimulation. RESULTS: T200/T1 ratios produced by succinylcholine (SCC) and decamethonium (C10) were located between alpha-bungarotoxin (ABX) and hexamethonium (C6), however, significant differences among the four drugs were found at 2.0 Hz. The propensity for a decrease in T200/T1 ratios at 2.0 Hz might differ from this study: C6 > C10 > SCC > ABX. T200/T1 ratios at 2.0 Hz were not different from TOF ratios. CONCLUSIONS: It is concluded that small doses of C10 have a greater presynaptic activity than that of SCC, when the observed effects in this study were compared with the result of ABX acting predominantly at postsynaptic receptors and C6 acting predominantly at presynaptic receptors.
Animals ; Baths ; Bungarotoxins ; Depression ; Hexamethonium ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents* ; Oxygen ; Phrenic Nerve ; Rats ; Receptors, Presynaptic ; Succinylcholine

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Neuromuscular Blocking Properties of beta-Bungarotoxin, Hexamethonium and Verapamil in the Rat Phrenic Nerve-Hemidiaphragm Preparation.

Sung Yell KIM ; Jeong Seok LEE ; Sun Chong KIM ; Sang Ho KIM ; Yong Ik KIM ; Soon Im KIM

Korean Journal of Anesthesiology.2001;40(4):522-531. doi:10.4097/kjae.2001.40.4.522

BACKGROUND: beta-Bungarotoxin irreversibly changes the presynaptic membrane, hexamethonium acts on the presynaptic nicotinic receptor, and verapamil blocks the ion channels on the presynaptic membrane. The effect of these drugs on twitch height and train of four (TOF) ratio were investigated, as well as the reversal effects of neostigmine, pyridostigmine or 4-aminopyridine (4-AP) on the partial neuromuscular blockade induced by these drugs. METHODS: Square wave, 0.1 Hz supramaximal stimuli or 2 Hz, 0.2 ms train of four stimuli, was applied to the phrenic nerve-hemidiaphragm preparation of the rat, and the twitch height response was recorded mechanomyographically. The cumulative concentration effects and TOF ratios at each point of twitch depression after beta-bungarotoxin, hexamethonium or verapamil were measured. TOF ratios were observed at 75, 50 and 25% of the control twitch height value during observation of the concentration effect. The EC50 and EC95 of beta-bungarotoxin, hexamethonium or verapamil were calculated using an inhibitory sigmoid Emax model. The reversal effect of some doses of neostigmine, pyridostigmine or 4-aminopyridine to the partial neuromuscular block produced by EC50 of beta- bungarotoxin, hexamethonium or verapamil was determined. RESULTS: The EC50 and EC95 of beta-bungarotoxin, hexamethonium and verapamil were 0.0695 and 0.1160 microgram/ml, 1267.0 and 2033.5 microgram/ml and 29.45 and 37.99 microgram/ml respectively. TOF fade was marked with hexamethonium or verapamil but small with beta-bungarotoxin. Neostigmine or pyridostigmine did not reverse the partial neuromuscular block induced by beta-bungarotoxin, hexamethonium or verapamil. However, 4-AP produced a dose-dependent recovery of the twitch response (P < 0.05). CONCLUSIONS: beta-Bungarotoxin, hexamethonium and verapamil produced different degree of TOF fade, and this may be due to different sites of action of these drugs. 4-AP reversed effectively the partialneuromuscular block induced by beta-bungarotoxin, hexamethonium and verapamil, whereas, neostigmine and pyridostigmine did not.
4-Aminopyridine ; Animals ; Bungarotoxins* ; Colon, Sigmoid ; Depression ; Hexamethonium* ; Ion Channels ; Membranes ; Neostigmine ; Neuromuscular Blockade* ; Pyridostigmine Bromide ; Rats* ; Receptors, Nicotinic ; Verapamil*

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Comparison of Poloxamer-407 to Soybean Oil as an Emulsifying Agent for Propofol: Histamine Release and Plasma Lipid Levels.

Hyun Hwa LEE ; Ho Yeong KIL ; Tae Hyun HAN ; Hoon PARK ; Sung Il SHIN ; Hyun Jung YANG ; Min Ku KIM ; Dae Woo KIM

Korean Journal of Anesthesiology.2001;40(4):515-521. doi:10.4097/kjae.2001.40.4.515

BACKGROUND: To reduce side effects (hyperlipidemia, pain on injection, etc.) of the present formation of propofol, many attempts to change the emulsifying agent for propofol have been tried. This study was designed to examine the poloxamer-407 as an emulsifying agent for propofol compared to soybean oil regarding histamine release and plasma lipid levels. METHODS: Twelve Beagle dogs weighing 12 - 16 kg were randomly assigned to one of two groups according to the formulation of propofol. Group 1 received Diprivan propofol 1% (AstraZeneca Co. UK), and group 2 received poloxamer-407 formulated propofol by a continuous intravenous infusion at 30 mg/kg/h for 3 hours. Three, 6, 9 and 12 hours after discontinuing the propofol infusion, venous blood samples from the cranial tibial vein were analysed by an ELISA kit for the histamine level. Also, blood lipid levels were checked 3 hours after the infusion and blood propofol concentration were checked every hour during the infusion. RESULTS: Group 2 showed significantly less histamine release than group 1 at 3, 6 and 9 hours after the infusion (P < 0.05). In the plasma lipid study, there was no difference in high-density lipoprotein (HDL) between the two groups, but triglyceride and cholesterol were significantly higher in group 2 (P < 0.05). There was no difference in propofol concentrations between the two groups. CONCLUSIONS: Poloxamer-407 as an emulsifying agent for propofol showed no advantage compared to a present formulation regarding hyperlipidemia, and even decreased the histamine level.
Animals ; Cholesterol ; Dogs ; Enzyme-Linked Immunosorbent Assay ; Histamine Release* ; Histamine* ; Hyperlipidemias ; Infusions, Intravenous ; Lipoproteins ; Plasma* ; Propofol* ; Soybean Oil* ; Soybeans* ; Triglycerides ; Veins

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The Analgesic Effect of Combined Infusions of Morphine and Ketamine Using an Intravenous PCA after a Cesarean Section.

Chang Jae KIM ; Jun Seuk CHEA ; Mee Young CHUNG ; Dae Heon SONG ; Jeong Joo PARK ; Byung Ho LEE

Korean Journal of Anesthesiology.2001;40(4):509-514. doi:10.4097/kjae.2001.40.4.509

BACKGROUND: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is known to have analgesic properties in subanesthetic doses and has been used as an analgesic in the postoperative period by variable routes. The effect of adding ketamine to analgesia using intravenous PCA morphine was evaluated in 90 women after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The parturients in group 1 were given analgesics of morphine only, group 2 were given analgesics of the 2 : 1 mixture of morphine and ketamine, and group 3 were given analgesics of the 1 : 1 mixture of morphine and ketamine. We evaluated the analgesic requirement, numerical rating pain score, side effects and patient's satisfaction. RESULTS: The morphine requirement in group 3 was significantly lower than that in groups 1 and 2 at 3, 6, 12, 24 and 48 hours postoperatively. The pain score in group 2 was lower than that in group 1 at 3 and 6 hours and the pain score in group 3 was lowest of all groups at 3 and 6 hours. The incidence of dizziness was higher in group 3 than in groups 1 or 2. CONCLUSIONS: We concluded that adding ketamine with morphine in using an intravenous PCA can decrease analgesic requirements and improve analgesic property.
Analgesia ; Analgesics ; Cesarean Section* ; Dizziness ; Female ; Humans ; Incidence ; Ketamine* ; Morphine* ; N-Methylaspartate ; Passive Cutaneous Anaphylaxis* ; Postoperative Period ; Pregnancy

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The Combined Effect of Epidural Tramadol and Clonidine for Postoperative Analgesia.

Yong Hun CHUNG ; Kyung Joon LIM

Korean Journal of Anesthesiology.2001;40(4):503-508. doi:10.4097/kjae.2001.40.4.503

BACKGROUND: The efficacy of epidurally administered tramadol hydrochloride, a weak centrally acting analgesic, was studied for the relief of postoperative pain. Clonidine, an alpha2 adrenergic agonist, has nonopiate antinociceptive properties which might be an alternative for postoperative analgesia free of undesirable effects from opioids. The aim of this study was to evaluate the postoperative analgesic effects of an epidural administration with a combination of tramadol and clonidine. METHODS: Sixty patients undergoing lower abdominal surgery were randomly allocated to three treatment groups to be given the following agents by the epidural route: group 1, 10 ml of bupivacaine 0.125%; group 2, 10 ml of bupivacaine 0.125% with tramadol 50 mg; group 3, 10 ml bupivacaine 0.125% with tramadol 50 mg and clonidine 100 microgram. In the recovery room, postoperative analgesia was assessed by the visual analogue scale (VAS) at 30 min, 1, 2, 3, 4, 5 and 6 hour. Vital signs, sedation score and side effects were also checked. RESULTS: VAS scores were significantly lower in group 3 than group 1. In addition, VAS scores were significantly lower in group 3 than group 2 at 4 and 5 hours. Blood pressure, heart rate and sedation scores were not significantly different among the three groups. CONCLUSIONS: The combination of epidural 0.125 % bupivacaine, tramadol 50 mg and clonidine 100 microgram produces more profound and longer postoperative analgesic effects than 0.125% bupivacaine and tramadol 50 mg or only 0.125% bupivacaine for the lower abdominal surgery.
Adrenergic Agonists ; Analgesia* ; Analgesics, Opioid ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Humans ; Pain, Postoperative ; Recovery Room ; Tramadol* ; Vital Signs

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