Acute and Critical Care

Noninvasive Positive Pressure Ventilation: Min Ki Lee; Korean J Crit Care Med. 1997;12(1):1-4.

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Abstract PDF: No abstract available.

Role of Nitric Oxide in Sepsis: Seong Wan Baik; Korean J Crit Care Med. 1997;12(1):5-8.

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Abstract PDF: No abstract available.

Inotropic Agents: Young Lan Kwak; Korean J Crit Care Med. 1997;12(1):9-18.

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Abstract PDF: No abstract available.

Antiarrhythmic Agents: Yong Woo Hong; Korean J Crit Care Med. 1997;12(1):19-30.

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Abstract PDF: No abstract available.

Comparison of Initial Weaning Success Rates and Weaning Periods between Synchronized Intermittent Mandatory Ventilation and Pressure Support Ventilation: Joong Hyuk Yang, Kyoung Min Lee, Hyun Kyung Lim, Dae Ja Um, Ryung Choi; Korean J Crit Care Med. 1997;12(1):31-36.

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Abstract PDF: 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.

Clinical Study for Monitored Anesthesia Undergoing Ophthalmic Surgery: Jeong Won Lee, Suk Hun Yoon, Tae Seong Kim, Hyun Soo Kim, Kwang Min Kim; Korean J Crit Care Med. 1997;12(1):37-42.

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Abstract PDF: Intoduction: The phrase "Monitored Anesthesia Care" refers to instances in which an anesthesiologist has been called upon to provide specific anesthesia services to a particular patient understanding a planned procedure, in connection with which a patient receives local anesthesia. Monitored anesthesia care is being increasingly used in the 1990s for a wide variety of diagnostic and therapeutic procedure. The primary objective in providing monitored anesthesia care is to ensure patient comfort and safety.
METHOD
We classified patients in three groups by premedication and oxygen administration, no premedication and no oxygen administration (group A), premedication and oxygen administration (group B), premedication and no oxygen administration (group C), measured vital signs and SpO2 (peripheral oxygen saturation) from just before operation, and checked the satisfaction score of surgeon and patients.
RESULT
SpO2 and satisfaction score of surgeon and patients are the best at premedication and oxygen administration group.
CONCLUSION
Monitored anesthesia is assumed to give more comfort and safety to patients than local anesthesia alone.

Differences of Incidence and Severity of Sore Throat and Hoarseness between the Methods of Airway Security: Yeoung Hwan Choi, Hee Chung Kim; Korean J Crit Care Med. 1997;12(1):43-48.

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Abstract PDF: Introduction: The sore throat and hoarseness are common complications during the postoperative period. We investigated differences of incidence and severity of sore throat and hoarseness according to methods of airway security.
METHODS
One hundred twelve patients, in ASA physical status class 1~2, were included in this study (58 males and 54 females). They were divided into three groups: group 1 (n=42), intubated with endotracheal tube lubricated with normal saline; group 2 (n=40), intubated with endotracheal tube lubricated with 5% lidocaine ointment; group 3 (n=30), inserted with laryngeal mask airway (LMA) for airway security.
RESULTS
The incidence of sore throat and hoarseness were 78.6% and 54.8% in group 1, 35% and 30% in group 2, and 33.3% and 20.0% in group 3.
CONCLUSIONS
Both 5% lidocaine-lubricated endotracheal tube and laryngeal mask airway showed tendency of decreased incidence of postoperative sore throat and hoarseness but there are no statistical significance.

The Adequate Timing of Arterial Blood Sampling during the Changes of Inspired Oxygen Fraction by Nitrous Oxide: Jong In Oh, Soo Won Oh, Gill Hoi Koo; Korean J Crit Care Med. 1997;12(1):49-56.

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Abstract PDF: BACKGOUND: Arterial blood gas analysis is essential on diagnosis and treatment of hypoxia and acid-base imbalance. It is important to decide the timing of arterial blood sampling as well as sampling method, sample transport, and analysis of the results. So we investigated to the adequate timing of sampling when inspired oxygen fraction is changed from 0.5 to 1.0.
METHODS
20 patients were anesthetized with enflurane-N2O-O2 (FiO2=0.5), and paralyzed with pancuronium 0.07~0.08 mg/kg. Ventilation was controlled with Ohmeda 7000 ventilator (BOC Health Care Inc., Madison, USA), using a constant tidal volume of 10 ml/kg and respiration rate of 12/min. After 1 hour of anesthesia, the nitrous oxide inhalation was stopped and 100% oxygen was inhaled, and then arterial blood gas values were measured at 2 min intervals for 20 min, 5 min intervals for next 30 min, and 10 min later. Blood samlpes were drawn from the radial artery and measured immediately on a blood gas analyzer (Civa-Corning 288 Blood Gas System, Civa-Corning Diagnostic Corp., Medifield, USA). Determining the optimal time of sampling was performed with the rate of variation of PaO2 according to time progression, then the point at which the slope decreased abruptly was regarded as statistically significant timing.
RESULTS
After 12 minute, arterial oxygen partial pressure was not any more changed significantly. There were no change of pH, arterial carbon dioxide partial pressure, oxygen saturation, base excess, and bicarbonate.
CONCLUSION
The timing of arterial blood gas sampling in change with inspired oxygen fraction from 0.5 to 1.0 is about 12 minute later.

A Statistical Analysis of Postoperative Deaths in the Hospital: Dong Ai An, Byung Ki Kim, Hack Ju Park, Hang Soo Sohn; Korean J Crit Care Med. 1997;12(1):57-64.

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Abstract PDF: Introduction: Anesthesia deaths are rare, while deaths due to surgical or other risk factors are more frequent. The goal of this analysis is to evaluate risk factors associated with postoperative mortality.
METHODS
We have analyzed 34,200 surgical patients between 1990 and 1996 through records of anesthesia. The following informations were recorded; age of patients, physical status, site of operation, time of death, primary cause of death.
RESULTS
The results are as follows; 1) Of 34,200 surgical patients, 119 died in the hospital. 2) The postoperative mortality rose progressively with age and was highest above 70 years. 3) Within 48 hours, the mortality was 36.1% of total deaths, declined progressively thereafter. The patients who had head operations exceeded 45% of deaths during this period. Eight days after the operation the mortality rate was 34.2% of total deaths and the patients who had an elective operation of the abdomen were 60.8%. 4) 34.2% patients of the total deaths had brain damages. Of these, 79.5% showed physical status V and had an emergency head operation and 47.5% were 50~60 years of age. 17.5% and 13.2% of deaths were due to sepsis and respiratory insufficiency and 48.6% of these two categories were physical status II, III and had an elective operation and 55.5% were above 60 years.
CONCLUSION
The postoperative mortality was highest in the patients who had an emergency head operation and primary cause of death was brain damage. The patients of above 60 years, had a physical status II, III, had an elective abdominal operation were succeptable to sepsis and respiratory insufficieny.

Reliability of Pulse Oximetry in Severe Hypoxemic Children with Congenital Heart Disease: Chung Hyun Park, Sou Ouk Bang; Korean J Crit Care Med. 1997;12(1):65-68.

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Abstract PDF: Introduction: Oxygen delivery to tissue is of major clinical interest in patients with cyanotic congenital heart disease (CHD). The use of pulse oximeter to monitor arterial oxygen saturation (SaO2) is considered accurate and reliable in the range of 90% to 100%. However with desaturation, the accuracy remains controversial below 90%. The aim of this study was to evaluate the accuracy of pulse oximetry in severe hypoxemia.
METHOD
In 110 children with cyanotic CHD, pulse oximeter (N-200, Nellcor, USA) readings were compared with the direct measurement of SaO2 by blood gas analyser (Profile10, Stat, USA). All measurements were carried out after induction of anesthesia and devided into 4 groups according to saturation measured by pulse oximeter (SpO2). SpO2 in group I was higher than 90% (n=90), in group II between 80% and 89% (n=75), in group III between 70% and 79% (n=41), in group IV lower than 69% (n=18). Statistical analysis of paired SpO2 and SaO2 values was performed using correlation analysis and paired t-test. The other comparisons were perfomed with ANOVA. p<0.05 was considered statistically significant.
RESULTS
Correlation coefficient of group I was 0.89 (p<0.01), group II was 0.67 (p<0.01), group III was 0.63 (p<0.01) and group IV was 0.41. The study demonstrate that SpO2 seems to have good correlation with SaO2 when SpO2 is higher than 70%. This results are contrary to other studies which show that SpO2 is not reliable when SpO2 is below 90%. However, the correlation value r seems to decrease with desaturation.
CONCLUSION
The use of pulse oximeter in severe hypoxemic children with CHD is efficient in monitoring oxygenation, even though there is decrease in accuracy of the SpO2.

The Effect of Cervical Sympathetic Nerve Block on Blood-brain Barrier Disruption with Mannitol Infusion in Rats: Bong Ki Moon, Soo Han Yoon, Young Joo Lee, Chul Ryung Hur, Chang Ho Kim, Sung Jung Lee, Young Seok Lee; Korean J Crit Care Med. 1997;12(1):69-74.

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Abstract PDF: BACKGOUND: The barrier can be altered by a number of insults to the brain (e.g., hypertension, freezing, trauma, drug). But the effect of the blood brain barrier distruction immediately after the neural change is unknown. In the present study, we focused on the BBBD after cervical sympathetic chain block.
METHODS
13 male Sprague-Dawley rats were divided into 2 groups. Group 1 (N=7) was blocked with 0.5% bupivacaine on the right cervical sympathetic chain and group 2 (N=6) was blocked with 0.5% bupivacaine on the bilateral cervical sympathetic chain. All rats received 37degrees C, 25% mannitol (1.75 g/kg) via right carotid artery and then, the effect of cervical sympathetic chain block on blood-brain barrier disruption of four cerebral compartment using 99mTc-human serum albumin and Evans blue was evaluated.
RESULTS
Both groups showed blood-brain barrier disruption and there was no significant difference between group 1 and group 2 in the anterior and posterior hemisphere of the right side brain. But group 2 showed significant blood-brain barrier disruption than group 1 in anterior and posterior hemisphere of the left brain (p<0.01).
CONCLUSIONS
This results suggest that cervical sympathetic chain block can increase the degree of mannitol-induced blood-brain barrier disruption via neural arch or blood flow change.

Acute Lung Edema from Unknown Cause: A case report: Changgi Rho, Sang Wook Shin, Hae Kyu Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 1997;12(1):75-80.

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Abstract PDF: Acute lung edema during anesthesia and operation is not common. We experienced a case of 7 year-old boy who developed acute lung edema during open reduction for his fractured lateral condyle of right humerus under general anesthesia with enflurane. In his previous history, we couldn't detect any abnormal finding that could induce lung edema intraoperatively. Preoperative routine laboratory findings and chest x-ray findings were within normal ranges. In the end of operation, increased airway resistance and sudden facial cyanosis were detected and he received immediate, careful supportive respiratory management. He improved from severe lung edema, but hypoxic brain damage and motor dysfunction resulted. We couldn't find any evidence that he had heart failure, hypoalbuminemia, sepsis, severe trauma, fluid overloading. Authors couldn't get exact causes of acute lung edema in this case.

Combination Therapy of Verapamil and Esmolol for the Paroxysmal Supraventricular Tachycardia Recurred during the Central Venous Catheterization: A case report: Eun Jung Kwon, Myoung Hoon Kong, Sang Ho Lim, Joon Hyeuk Choi, Mi Kyoung Lee, Suk Min Yoon, Young Seok Choi; Korean J Crit Care Med. 1997;12(1):81-84.

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Abstract PDF: Combination therapy of beta-blocker and a calcium channel blocker is not recommened because their additive effect on the myocardium and the atrioventricular node may precipitate heart block in susceptible patients. We experienced a 68 years old female patient who had paroxysmal supraventricular tachycardia that was treated with verapamil and esmolol. She had been taking verapamil for 2 years because of her paroxysmal supraventricular tachycardia. She was planned for left ureteronephrectomy due to left ureteral tumor. After epidural catheterization for the postoperative pain control, she was anesthetized with isoflurane and vecuronium. During central venous catheterization, SVT (H.R. from 98 beats per minute to 190 BPM) was suddenly developed with hypotension (B.P. from 120/65 mmHg to 75/42 mmHg) when guide wire was introduced. We treated her with combination therapy of verapamil 7.5 mg and esmolol 18 mg under the monitoring of blood pressure, electrocardiogram, end-tidal CO2 tension, central venous pressure and pulse oximeter. After 20 minutes of vigorous treatment, her heart rate and blood pressure returned to a normal range.

Malignant Hyperthermia Syndrome: A case report: Ji Yeon Kim, Eun Jung Kwon, Mi Kyoung Lee, Sang Ho Lim, Suk Min Yoon, Young Seok Choi; Korean J Crit Care Med. 1997;12(1):85-88.

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Abstract PDF: Malignant hyperthermia (MH) is an inherited skeletal muscle disorder characterized by hypermetabolism, muscle rigidity, rhabdomyolysis, fever, metabolic acidosis and death if untreated. The syndrome is believed to result from abnormal control of intracellular calcium ions in the skeletal muscle: on exposure to certain anesthetics, calcium level is increased, and then it activates contractile processes and biochemical events that support muscle contraction. We experienced a MH of 2 years-old male who had release of sternocleidomastoid muscle due to torticolis under general anesthesia. Anesthesia was induced with thiopental and succinylcholine, maintained with enflurane, nitrous oxide and oxygen (2 volume%: 2 L/min: 2 L/min). After induction of anesthesia, his heart rate, end-tidal CO2 tension and body temperature had been gradually increased and then those were reached to maximal value of heart rate (160~170 BPM), end-tidal CO2 tension (60~70 mmHg) and body temperature (41degrees C) 55 minutes later. He was immediately managed with symptomatic treatment such as hyperventilation with oxygen, cooling, beta-blocker, sodium bicarbonate and diuretics, so he was survived without any sequelae.

Malignant Hyperthermia during General Anesthesia: Two cases: Eun Chung Cho, Eun Sung Kim, Young Ho Hong, Yeon Jang, Soo Seok Park; Korean J Crit Care Med. 1997;12(1):89-94.

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Abstract PDF: Malignant hyperthermia is a hypermetabolic disorder of skelectal muscle. It goes fatal progress in the majority of cases unless early diagnosis and treatment are performed. We experienced two cases of malignant hyperthermia during general anesthesia. First case is 7-year-old boy with congenital bilateral ptosis. Second case is 46-year-old male with lung cancer. We were faced to difficult intubation due to masseter muscle spasm. After induction, tachycardia, muscle rigidity, body temperature elevation, end tidal CO2 elevation and acidosis developed. Enflurane was discontinued, vigorous emergency treatment was attempted. Fortunately, two patients were recovered from malignant hyperthermia and then discharged without complications.

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