Acute and Critical Care

Servo Controlled Modes of Ventilation: Chul Hong Kim, Jae Young Kwon; Korean J Crit Care Med. 2002;17(1):1-4.

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Abstract PDF: No abstract available.

Noninvasive Positive Pressure Ventilation: Yun Seong Kim; Korean J Crit Care Med. 2002;17(1):5-11.

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Abstract PDF: No abstract available.

The Effects of Moderate Hypothermia on the Formation of Apoptosis in Transient F degrees Cal Cerebral Ischemia Model in Rats: Tae Jung Woo, Seong Wan Baik, Kyoo Sub Chung, Inn Se Kim, Hae Kyu Kim, Jae Young Kwon; Korean J Crit Care Med. 2002;17(1):12-18.

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Abstract PDF: BACKGROUND
Delayed neuronal injury after cerebral ischemia came major neurologic complication after stroke or cardiac arrest. Apoptosis formation after ischemia may be one of a mechanism of delayed neuronal injury. This study was conducted to evaluate the effect of moderate hypothermia on apoptosis formation after one hour of middle cerebral artery degrees Cclusion in rats.
METHODS
Ten Sprague-Dawley rats (300 g) were freely fed till just before operation. Anesthesia was induced with 4 vol% isoflurane in oxygen and then maintained with 2 vol% isoflurane in oxygen. Middle cerebral artery degrees Cclusion (MCAO) was induced by intraluminal monofilament nylon with blunted tip. All rats were divided randomly into two groups. In group 1 (n=5), rectal temperature was maintained at 38 degrees C. In group 2 (n=5), rectal temperature was maintained at 32 degrees C. Rectal temperature was monitored during experiment. After 60 minutes of MCAO, intraluminal monofilament was removed and all rats were returned to cages. Brain were quickly removed and cerebral hemispheres were separated after 23 hours reperfusion. Apoptosis formation were counted with TUNEL stain.
RESULTS
In group 1, after 60 minutes of MCAO and 23 hours reperfusion, 51 3.6% of hipp degrees Campal neurons were TUNEL-positive stained apoptotic cells. In group 2, TUNEL-positve neurons were 26.1 6.5% and significantly less than those of group 1 (p<0.05).
CONCLUSIONS
Sixty minutes of MCAO and 23 hours reperfusion induce hipp degrees Campal neuronal apoptosis. Moderate hypothermia of 32 degrees C reduces apoptosis of hipp degrees Campal neurons after 60 minutes of MCAO and 23 hours reperfusion.

The Effects of Chemotherapeutic Agents on Renal Function during Continuous Hyperthermic Peritoneal Perfusion: Jong Ho Choi, Eun Sung Kim; Korean J Crit Care Med. 2002;17(1):19-24.

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Abstract PDF: BACKGROUND
Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of the advanced cancer patients. It is a technique that allows uniform delivery of cytotoxic agents and heat to the peritoneal surface. However CHPP - induced acute changes of body temperature and intraabdominal pressure could produce various abnormal physiologic responses, especially hypoperfusion and hypoxia. These factors may further contribute to the renal dysfunction. Moreover, transperitoneal absorption of drugs resulting in systemic toxicity and certain anticancer drugs have an inherent nephrotoxicity. The aim of the present study was to investigate the effect of anticancer drugs on the kidney in the ovarian cancer patients after CHPP.
METHODS
CHPP with anticancer agents in warm saline was performed in 54 patients with cancer of the ovary at temperature 47 degrees C for 90 minutes under general anesthesia. Forty nine patients were given carboplatin and 5 patients were received cisplatin intraperitoneally at an equi-toxic dose. To clarify the effect of cisplatin and carboplatin on the kidney, serum creatinine and blood urea nitrogen (BUN) were measured before anesthesia, 1, 3 and 7th day after surgery in both agents.
RESULTS
There were no significant changes of creatinine level on 1, 3 and 7 days postoperatively compared to preoperative creatinine in carboplatin patients. In carboplatin patients, postoperative BUN levels were decreased significantly on 1 and 3 days, but they were within normal range. BUN level of postoperative 7 day showed no significant change. In cisplatin patient, there was insignificant increase of BUN and creatinine levels on 1, 3 and 7 days postoperatively.
CONCLUSIONS
These results suggest that carboplatin did not suppress renal function until 7 days after CHPP. Cisplatin markedly increased the creatinine and BUN until 7 days postoperatively, but there was no statistical significance.

Thumb Necrosis Following Radial Artery Cannulation: Seok Jai Kim, Seong Wook Jeong, Sang Hyun Kwak, Sung Su Chung, Woong Mo Im; Korean J Crit Care Med. 2002;17(1):25-28.

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Abstract PDF: Radial artery is frequently chosen for cannulation. Although the method is safe and simple, it can infrequently lead to tissue necrosis. This is a report of one case of amputation due to thumb necrosis developed from the radial artery cannulation in a patient who had open heart surgery. This is a 65 years old female who received a graft interposition of ascending aorta due to dissecting aortic aneurysm. Left radial artery cannulation was carried out after modified Allen's test appeared to be positive. On the 11 th postoperative days, we found that the catheter of left hand was obstructed, and we removed the catheter. On the 9 hrs after removal of catheter, thumb of left hand became color change and edematous with blister. On the 14 th days after removal of catheter, thumb of left hand became worsened to dusky purple to dark color change and pulseless, coldness. On the 20 th days after removal of catheter, amputation of thumb of left hand was performed.

Airway Partial Obstruction by Internal Hermiation of Armored Endotracheal Tube: A case report: Mijeung Gwak, Hyun Sook Hwang, Eun Ha Suk, Pyung Hwan Park; Korean J Crit Care Med. 2002;17(1):29-33.

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Abstract PDF: During general anesthesia, intubation with kink-resistant armored tubes permit the anesthesiologist to work some distance from the surgical field during operation on the head and neck or with patients whose unusual position may kink and obstruct a tube not so reinforced. But armored tubes are still subject to number of hazards, including herniation of the intra-luminal cuff or layer into the lumen of the tube. So extra care is required in their use. We report a case of intraluminal herniation of armored tube accompanied with peak inspiratory pressure during general anesthesia.

Difficult Endotracheal Intubation Due to Unrecognized Dysfunction of Temporomandibular Joint: A case report: Bong Jin Kang; Korean J Crit Care Med. 2002;17(1):34-37.

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Abstract PDF: In association with facial trauma, fracture of mandibular condyle occurs frequently. From that injury, the dysfunction of temporomandibular joint and the following limitation of mouth opening causing difficult intubation can result. So the anesthesiologists should have the capability of recognizing such problems. But in the case of facial trauma, pain and muscle spasm also cause similar but reversible conditions posing difficulty in differential diagnosis. In this case the patient showed some degree of limitation in mouth opening (1 finger breath) at the preoperative evaluation, so the author performed routine induction expecting the occurrence of full mouth opening after muscle relaxation. But the patient's mouth couldn't be opened any further and the exposure of epiglottis was impossible. Now since we have no reliable predictive criteria of irreversible temporomandibular joint dysfunction, awake fiberoptic intubation should be strongly considered in the case of condylar fracture with any limitations in mouth opening.

Use of Laryngeal Mask Airway ProsealTM in a Total Thyroidectomy for Huge Thyroid Tumor: A case report: Hyun Soo Kim, Yun Hong Kim, Hyun Woo Nam; Korean J Crit Care Med. 2002;17(1):38-41.

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Abstract PDF: This is a case of anesthesia for a 49 year old woman with huge thyroid tumor who was admitted for total thyroidectomy. General anesthesia for thyroidectomy has traditionally involved tracheal intubation. But, we failed orotracheal intubation as in ability to insert a tracheal tube from the oropharynx into the trachea. After laryngoscopy was attempted three times, a laryngeal mask airway ProSealTM (PLMATM), size 3, was requested. The device was passed easily, and a patent airway was obtained. During general anesthesia, patient was mechanically ventilated through the PLMATM to airway pressures of approximately 20 cmH2O and positive pressure ventilation without air leaks was possible. Total thyroidectomy was performed without hypoxia and hypercarbia.

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