Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced ; Hysterectomy ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Pregnant Women ; Resuscitation

BACKGROUND: In surgeries involving the upper extremities and breast, the blood pressure is frequently measured at the ankles. As the blood pressure is used as a pain indicator in the full surgical anesthesia, the ankle blood pressure higher than the brachial blood pressure may be misinterpreted by the anesthesiologist, in determining the depth of the anesthesia. This paper investigated whether the ankle blood pressure is significantly higher than the brachial blood pressure before the anesthesia induction, during induction, and after tracheal intubation. METHODS: Two hundred seventeen patients requiring general anesthesia for elective surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before the anesthesia induction, during induction, and after tracheal intubation. RESULTS: The ankle blood pressure was higher than the brachial blood pressure before induction, during induction, and after tracheal intubation. Ankle-brachial blood pressure differences were significantly higher before induction and after intubation as compared to that during induction. The correlation coefficient between the systolic ankle-brachial blood pressure difference before induction and that after tracheal intubation was 0.623. In 33 child patients with an ankle-brachial blood pressure index > or =1 before induction, there were no significant differences in the ankle-brachial blood pressure during induction. The brachial systolic blood pressure could be predicted by simple and multiple regression equations (R2 = 0.349-0.828). CONCLUSIONS: The results of the study suggest that the anesthesiologists need to consider the ankle-brachial blood pressure differences in monitoring the anesthesia, in cases where the brachial blood pressure cannot be measured during surgery.
Anesthesia ; Anesthesia, General ; Animals ; Ankle ; Blood Pressure ; Breast ; Child ; Humans ; Intubation ; Upper Extremity

BACKGROUND/AIMS: Capsule endoscopy (CE) has become a valuable modality for the detection of small bowel lesions. The usefulness of CE for obscure gastrointestinal (GI) bleeding has been established with an overall diagnostic yield of 60%. It is unknown whether CE is of equal value in all the patients or of greater benefit in selected groups in Korea. We evaluated the factors that affect the diagnostic yields of CE in patients with obscure GI bleeding. METHODS: CE was performed in 126 consecutive patients [74 men and 52 women mean age : 52.5 years (25-75 yrs), 23 with active bleeding] with obscure GI bleeding between September 2002 and July 2004. Patients were divided into two groups: those with documented bleeding lesions and those with non specific CE findings. We analyzed the clinical characteristics and other parameters that influenced the diagnostic yields of CE. RESULTS: A definite or probable cause for obscure GI bleeding was found in 69% (80/116) of the patients. NSAID induced ulcer (16.4%) and angiodysplasia (12.1%) were the most common diagnoses. In patients with active bleeding, the diagnostic yield was significantly greater than that of the patients with occult bleeding (80% vs. 68.3%, p<0.05). However, there was no significant difference in parameters between patients with abnormal CE and those with normal CE in respect to gender, age, previous bleeding history, need for transfusion, cecum imaging, and bowel preparation. CONCLUSIONS: The diagnostic yield of CE in patients with obscure GI bleeding is 69%. It is significantly higher in patients with active bleeding.
Adult ; Aged ; *Capsule Endoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology ; Humans ; Intestinal Diseases/*diagnosis ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity

Anesthesiologists are encountering an increasing number of human immunodeficiency virus (HIV) infections in pregnant women. In HIV infected patients, the history should include an evaluation of opportunistic infections, malignancies and treatments with antiretroviral drugs. The anesthesiologist should be aware of the possible toxic side effects or interactions between the antiretroviral drugs and anesthetics. In addition, a HIV infection passing from patient to physician can occur. Therefore, safety measures must be taken when handling body fluid or blood. We report the anesthetic management of an elective cesarean section in a HIV positive pregnant woman who was treated with antiretroviral drugs to decrease the possibility of vertical transmission.
Anesthetics ; Body Fluids ; Cesarean Section* ; Female ; HIV Infections ; HIV* ; Humans* ; Opportunistic Infections ; Pregnancy ; Pregnant Women*

We report our experience of the anesthetic management of an ex utero intrapartum treatment (EXIT) procedure that was performed on a fetus with a mandible anomaly (agnathia) for airway management. The EXIT procedure is a method for maintaining the feto-placental circulation during a cesarean section using deep inhalation anesthesia. In the EXIT procedure, the anesthetic goal is the profound relaxation of the uterus to maintain the feto-placental circulation. High dose inhalation agents are used maintain the level of uterine relaxation. Anesthesia was induced with rapid sequence intubation and maintained with 2 vol% isoflurane and nitrous in oxygen (50:50) combined with intermittent boluses of fentanyl and atracurium. The fetus was not given any drugs other than those as a result of placental transfer and was monitored with pulse oximeter. The mother and fetus were maintained hemodynamically stable with a preserved feto-placental circulation. After delivery, the uterine tone improved soon after discontinuing the isoflurane, and the pitocin infusion was begun. There were no signs of uterine atony in the postoperative period.
Airway Management ; Anesthesia ; Anesthesia, Inhalation ; Atracurium ; Cesarean Section ; Female ; Fentanyl ; Fetus* ; Humans ; Inhalation ; Intubation ; Isoflurane ; Mandible ; Mothers ; Oxygen ; Oxytocin ; Postoperative Period ; Pregnancy ; Relaxation ; Uterine Inertia ; Uterus

BACKGROUND: Recent interest in the use of normothermic blood cardioplegia is based on theoretical advantages over the traditional method of hypothermic myocardial protection. These reported advantages are a decrease in intraaortic balloon pump use, greater incidence of return to normal sinus rhythm, greater immediate cardiac outputs, and less time weaned from bypass after removal of the aortic cross-clamp. In addition to these advantages, normothermic blood cardioplegia offers the promise to resuscitate the ischemic myocardium and reduce the morbidity and mortality for patients with high-risk disease. This study was designed to compare the effects of cold crystalloid and normothermic blood cardioplegia on the postoperative recovery. METHODS: To evaluate the efficacy of cold versus normothermic cardioplegia, forty-four patients scheduled to undergoing valvular replacement surgery were selected to receive intermittent cold(4degrees C) crystalloid cardioplegia(n=22), group I or continuous normothermic(37degrees C) blood cardioplegia(n=22), group II. Cardiopulmonary bypass(CPB) and aortic cross-clamp(ACC) times were measured during the operation and patients were evaluated postoperatively for serum electrolytes, arterial blood gas analysis, blood pressure, heart rate, complications, ventilator periods and ICU stay. RESULTS: The ACC and CPB times were significantly longer in group II(165.9+/-44.8 min, 210.9+/-60.2 min) compared with group I(121.2+/-38.7 min, 149.7+/-38.1 min)(p<0.01). Group II patients had significantly higher serum potassium level(5.2+/-0.8 mEq/L) than group I(4.3+/-0.4 mEq/L) on the first postoperative day(p<0.01). ICU stay and ventilator period were not significantly different in two groups. There was no significant difference in postoperative complications and mortality rates between two groups. CONCLUSIONS: These results suggest that the continuous normothermic blood cardioplegia may be useful in myocardial protection during cardiac operation.
Blood Gas Analysis ; Blood Pressure ; Cardiac Output ; Electrolytes ; Heart Arrest, Induced* ; Heart Rate ; Heart* ; Humans ; Incidence ; Mortality ; Myocardium ; Postoperative Complications ; Potassium ; Thoracic Surgery* ; Ventilators, Mechanical

BACKGROUND: Malpositioning of the endotracheal tube within airway after intubation may results in serious complications, such as accidental extubation and inadvertent endobronchial intubation. Therefore, early detection of malposioning of the endotracheal tube is very impotant for deciding patient's prognosis. METHODS: We assessed the distance from the tip of the endotracheal tube to the carina according to the patient's age, sex, and the time, the location, and the route of intubation. The chest x-ray was taken for 333 patients (men, 226: women, 107) who were admitted to the intensive care unit of Wonju Christian Hospital from march 1, 1995 to February 28, 1996. Chest x-ray was obtained after intubation to verify endotracheal tube position. Appropriate endotracheal tube position on chest x-ray was defined as between 2 and 6 cm above the carina. RESULTS: Of the 333 intubations, 106 (31.8%) endotracheal tubes were inappropriately placed according to the chest x-ray. The percentage of malpositioned endotracheal tubes (<2 cm) was higher in women than in men (11.2% vs. 5.3%, p<0.05), with higher in night (7 PM to 7 AM) than in day (7 AM to 7 PM) (42% vs. 24%, p<0.05). Distance from the carina to the tip of endotracheal tube is 4.34 +/- 1.77cm in women and 5.23 +/- 1.64cm in men. Thus, position of the endotracheal tube in women is deeper than men (p<0.001). CONCLUSIONS: We conclude that the chest x-ray for confirmation of endotracheal tube position after endotracheal intubation may remain the standard of practice. And endotracheal tube position should be carefully assessed immediately after tracheal intubation, particularly in women and at night.
Female ; Gangwon-do ; Humans ; Incidence* ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Male ; Prognosis ; Thorax*

BACKGOUND: SIMV (synchronized intermittent mandatory ventilation) mode is comprised of a ventilator that intermittently enters the volume assist/control mode in conjunction with circuitry that allows for spontaneous ventilation by a demand flow system. There is additional work of breathing caused by the endotracheal tube and demand valve in SIMV. However, PSV (pressure support ventilation) has the ability to decrease work of breathing and to augment spontaneous breaths with a variable amount of inspiratory positive pressure with a clinician-selected level of inspiratory airway pressure. METHODS: To compare the initial weaning success rates and weaning periods between SIMV and PSV, we reviewed medical records of 103 intensive care unit patients, who had received mechanical ventilatory support and performed weaning. We compared the patients' characteristics, initial weaning success rates and ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays according to the weaning process (SIMV and PSV). And then we compared the same variables as the above between the initial weaning success group and initial weaning failure group. RESULTS: Patients' characteristics, ventilatory periods, weaning periods, ICU stays were similar, but there was significantly shorter weaning periods/ventilatory periods on PSV group. Initial weaning success rates according to the weaning process were similar. Ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays were significantly shorter on initial weaning success group. CONCLUSIONS: PSV could be used effectively as one of the weaning modes, and further studies are required about weaning criteria, weaning start time and weaning methods.
Humans ; Intensive Care Units ; Medical Records ; Ventilation* ; Ventilators, Mechanical ; Weaning* ; Work of Breathing

BACKGROUND: In biological structures, application of a constant alternating low current results in an impedance to the spread of the current that is frequency dependent. The living organism consists of intra- and extracellular fluids that behave as electrical conductors, and cell membranes that act as electrical condensers. Body fluids and electrolytes are responsible for electrical conduction. METHODS: We studied body impedance and fluid loss during hemodialysis in 20 patients with chronic renal failure. Two pairs of electrodes with a thin layer of electrolyte gel were placed on the dorsal surfaces of the hands and feet. 50KHz 800uA current was applied via the distal electrodes of each pair and the voltage drop was measured by proximal electrodes and impedance was derived from Ohms law. We measured body impedance and fluid loss at every one hour during hemodialysis. RESULTS: Body impedance value according to weight before hemodialysis changed in inveise ratio. During hemodialysis the rate of increase of body impedance according to body fluid loss revealed individual variance, but it was nearly constant in each individual patient. CONCLUSIONS: The method assessing total body water by body impedance is very simple, safe, rapid and noninvasive. The change of total body water can be predicted with body impedance method in individual patient by continuous monitoring, and this method may be useful particularly in critically ill patient. Further validation of this method is required for clinical application.
Body Fluids ; Body Water* ; Cell Membrane ; Critical Illness ; Electric Impedance* ; Electrodes ; Electrolytes ; Extracellular Fluid ; Foot ; Hand ; Humans ; Jurisprudence ; Kidney ; Kidney Failure, Chronic* ; Renal Dialysis* ; Renal Insufficiency