Acute and Critical Care

Acute Respiratory Failure in Patients with Chronic Obstructive Pulmonary Diseases: Yong Chul Lee; Korean J Crit Care Med. 1999;14(1):1-5.

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Abstract PDF: No abstract available.

Evaluation of Disorders of Mentation: Dong Chan Kim; Korean J Crit Care Med. 1999;14(1):6-13.

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Abstract PDF: No abstract available.

Antibiotic-Resistant Bacteria and Antibiotic Treatment in the Critical Care Unit: Woo Joo Kim; Korean J Crit Care Med. 1999;14(1):14-21.

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Abstract PDF: No abstract available.

Prevention and Management of Infections in the Critically Ill: Myoung Hoon Kong; Korean J Crit Care Med. 1999;14(1):22-26.

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Abstract PDF: No abstract available.

Clinical Survey of Patients in the Post-Anesthesia Care Unit: Sung Su Chung, Myung Gi No, Seong Wook Jeong, Sang Hyun Kwak, Woong Mo Im; Korean J Crit Care Med. 1999;14(1):27-30.

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Abstract PDF: BACKGOUND: The purpose of this study was to evaluate characteristics and mortality rates of patients admitted to the post-anesthesia care unit (PACU) for obtaining the better clinical guidances and more advanced therapeutic plan in the future.
METHODS
The medical records of total 425 patients admitted to the PACU from January to December 1998 were reviewed and analyzed according to age, sex, department, duration of stay, mechanical ventilator care, and mortality rates.
RESULTS
Patients admitted PACU were 6% of total anesthesia patients. The ratio of male to female was 1.5:1. Patients of manhood aged from 45 to 64 were 37%, pediatric patients under 15 year-old were 23%. and elderly patients over 64 year-old were 18% of total PACU patients. The ratio of patients with ventilatory support was 42%. Mortality rate of neonate under 1 month of age was about 47%. Total mortality rate was 12%.
CONCLUSIONS
To improve the outcome of the patients in PACU, continuous nutritional and medical support, cardiovascular and pulmonary monitoring, appropriate nursing care, and availability of medical staff were needed.

Succinylcholine-Induced Fasciculation is Prevented by Mivacurium-Precurarization: Kum Hee Chung, Jeong Wan Kang, Jong Yeon Lee; Korean J Crit Care Med. 1999;14(1):31-36.

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Abstract PDF: BACKGOUND: Succinylcholine (SCC) injection may be associated with adverse effects including elevated serum potassium (K ) and creatinine phosphokinase (CPK) level, and postoperative myalgia. Many studies have been made to prevent these adverse effects such as pretreatment with non-depolarizing muscle relaxants. The effects of the pretreatment with vecuronium or mivacurium, a new non-depolarizing neuromuscular blocker, on SCC-induced fasciculation, serum K and CPK level was investigated in this study.
METHODS
ASA physical status I or II, 40 patients were allocated randomly into 4 groups. Group I as a control group received SCC 1 mg/kg only, while the other groups were pretreated with vecuronium 0.02 mg/kg (0.4 x ED95) (group II), mivacurium 0.02 mg/kg (0.25 x ED95) (group III) and 0.03 mg/kg (0.4 x ED95) (group IV) before the SCC 1.5 mg/kg injection, respectively. Serum K concentration was measured just before anesthetic induction and 5 minute after SCC injection, and serum CPK was estimated before induction and at 24~36 hours postoperatively. And the fasciculation after SCC injection was graded by Cullen's suggestion.
RESULTS
Serum K concentration was increased in group I and decreased in pretreated groups, but the difference was not significant within each group and between the groups. Serum CPK level was increased in group I, II and IV but these changes were also insignificant between all groups. The grade of SCC-induced fasciculation was attenuated in group II and IV (p<0.05).
CONCLUSIONS
Like vecuronium, mivacurium 0.03 mg/kg is effective to reduce fasciculation after SCC injection, but 0.02 mg/kg is not. However, any complication does not occur in the two dosages.

Cutting of Guide Wire and Hydrothorax after Subclavian Venous Catheterization for Premature Infant: A case report: Hyun Soo Moon, Sung Hee Han; Korean J Crit Care Med. 1999;14(1):37-41.

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Abstract PDF: Central venous catheterization is one of the common procedures in the care of critically ill patients but numerous major complications have been reported. This report is about a case of sequential complications that were developed after two attempts of subclavian venous catheterization via supraclavicular approach for a critically ill 1.5 kg premature infant in intensive care unit. In the first attempt, the guidewire was cut and remained in the right atrium but fortunately removed without surgery. In the second attempt for the same patient, the catheter positioned out of the vessel. It was in right pleural cavity and caused hydrothorax. After third attempt, successful left subclavian vein catheterization was done.

Severe Hyperkalemia without Typical Electrocardiographic Manifestations: A case report: Sang Beom Nam, Hee Koo Yoo; Korean J Crit Care Med. 1999;14(1):42-46.

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Abstract PDF: Severe hyperkalemia can induce life threatening cardiac rhythm disturbances, and usually produce classic electrocardiographic (EKG) manifestations. We report a case of severe hyperkalemia in which the EKG did not reveal the expected alterations. The patient was a 57-year-old man with adenocarcinoma of stomach. There were no significant abnormal findings in laboratory analysis, chest X-ray and EKG. His preoperative medications for hypertension consisted of furosemide, amiloride and enalapril. The tests for serum potassium concentration ([K ]) were performed on 20 and 7 days before the operation and the results were 4.5 and 4.9 mEq/l, respectively. Just after induction of anesthesia, we tried the blood gas and electrolyte analysis and the result revealed high [K ] of 8.5 mEq/l, but EKG did not show typical phenotype of hyperkalemia at that time. His intraoperative and postoperative courses were not eventful.

Misconception of Bilateral Vocal Cord Paralysis as Laryngeal Spasm after Endotracheal Extubation: Bong Jae Lee, Jae Yong Jeong, Doo Ik Lee, Dong Soo Kim; Korean J Crit Care Med. 1999;14(1):47-51.

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Abstract PDF: We recently experienced an unexpected episode of bilateral vocal cord paralysis following endotracheal extubation after uvulopalatopharyngoplasty and tonsillectomy in 64-year-old man. The patient had no any other clinical manifestations regarding larynx or vocal cord except sleep apnea syndrome prior to this operation. The surgical procedure lasted almost 120 minutes and surgery and anesthesia was uneventful. After restoration of his spontaneous respiration, we tried extubation as usual method. Regardless his effort of spontaneous respiration for several times, he was suddenly apneic and showed declining of arterial oxygen saturation on the pulse oximeter (SpO2). Then we tried reintubation as a decision of laryngeal spasm. This alternative episode of extubation and reintubation was tried again and the causative factor of this respiratory impairment was confirmed as bilateral vocal cord paralysis by fiberoptic bronchoscopic examination in the operating room. Almost two thirds of vocal cord function was restored after six months of operation.

Postoperative Unstable Angina Pectoris Occured in the Recovery Room: Case report: Myoung Oak Kim; Korean J Crit Care Med. 1999;14(1):52-57.

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Abstract PDF: The leading cause of death after anesthesia and operations is cardiac complications, defined as myocardial infarction, unstable angina, congestive heart failure. We experienced a case of transient chest pain mimicking to myocardial ischemia after total intravenous anesthesia using propofol. The patient was 56 year-old female who underwent metatarsal osteotomy and distal soft tissue procedure. There was no specific abnormality on preoperative laboratory tests. Anesthesia induction and intraoperative course were completely uneventful. Immediately after transfered to the recovery room, the patient revealed transient cyanosis and complained anterior chest pain with tightness after fully awakening. In the study of electrocardiogram, there were ST abnormality in II, III, AVF and then T inversion in II, III, AVL, AVF, V2-6 leads. In the simultaneous study of echocardiogram, there was hypokinetic wall movement in the distal septum area. After treatment of nitroglycerine, the pain was subsided and the patient was discharged without any sequelae.

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