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Acute urinary retention is a common complication following anorectal surgery. However, the cause of this complication is poorly understood. We investigated the influence on postoperative urinary retention of age, sex, premedicants, intraoperative fluid volume administered, surgeon, operating time, type of operation, anesthetic technique in 278 patients undergoing elective surgery for benign anorectal disease by a review of the charts. The results were as follows. The overall urinary retention rate was 31.7%. Age, sex, premedicants (narcotics, anticholinergics), surgeon did not correlate with urinary retention. Increasing age was associated with a relatively high incidence of urinary retention, but the difference did not reach statistical significance (P=0.054). The variables of intraoperative fluid volume administered ($gt;200 ml), anesthetic technique (spinal anesthesia vs. general or caudal anesthesia), type (hemorrhoidectomy, especially including multiple mucosal ligation or sphincterotomy) of the operation, and operating time ($gt;30 min) correlated significantly with retention (P$lt;0.05). Urinary retention was 2, 7 and 3 times more likely to occur in patients who had duration of operation more than 30 minutes, hemorrhoidectomy, and spinal anesthesia respectively. After all above variables were controlled for, duration and type of the procedure and anesthetic technique remained significantly correlated with retention (P$lt;0.05). We concluded that operating time of more than 30 minutes, hemorrhoidectomy (especially using multiple mucosal ligations or sphincterotomy), and spinal anesthesia were significant precipitating factors, but could not determine whether age and intraoperative fluid volume administered were associated with urinary retention with this retrospective study.
A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.
Background : Lidocaine sprayed down the endotracheal tube (ETT) before extubation and during ETT removal was reported to prevent increases in blood pressure and heart rate during and after extubation. We hypothesized that lidocaine administered via this route would suppress the cough reflex associated with tracheal extubation. Methods : Eighty-five patients requiring intubation in the supine position were studied. All patients received a standardized anesthetic protoco. At the end of surgery, the patients were randomly divided into three groups and given no drug (group 1-control), given 1 ㎎/㎏ 2% lidocaine sprayed down the ETT 5 minutes prior to extybation (group 2), or given intravenous lidocine (IVL) 1 ㎎/㎏ 3 minutes prior to extubation (group 3). Extubation was performed when the patients met the criteria of extubation. Number of coughs was recorded from 5 minutes before until 5 minutes after extubation. Each value was compared among the three group. Conclusions : Lidocaine sprayed down the ETT suppresses cough reflex and is more effective than IVL in blunting the cough reflex. This study indicates that lidocaine sprayed down the ETT has a topical anesthetic effect suppressing the cough reflex. (Korean J Anesthesiol 2002; 42: 36~42)
승모판 치환술이 예정된 10명의 환자를 대상으로 심폐우회술 동안 발생할 수 있는 뇌산소 요구량과 소모량 사이의 불균형을 조사하기 위해 내경정맥내의 산소포화도를 체외순환 5분전과 시작후 1분이내, 저체온 상태가 안정되었을 때와 재가온하여 체온이 34℃가 되었을 때, 그리고 체외순환 종료후 15분 이내 등 5단계로 나누어 혈액을 채취하여 평균 동맥압, 체온, 동맥내 이산화탄소 분압, 혈색소치, PH 등을 비교 분석하여 다음과 같은 결과를 얻었다. 1. 심폐우회술 중 이산화탄소 분압과 혈색소치 및 PH 의 특이한 변화는 없었다. 2. 체외순환 직후 체온 및 평균 동맥압과 혈색소치의 급격한 변화가 있었으나 임상적인 의미는 없었으며, SjO₂의 변화도 없었다. 3. 저체온 상태가 안정되었을때 SjO₂평균치가 72.4%이었으나 체온을 34℃로 재가온하였을 때 56.1%로 감소하였다. 4. 재가온 시기에 SjO₂감소를 예방하기 위해 재가온 속도를 천천히 하고 이산화탄소를 증가시킴으로써 뇌혈류를 증가시키고 마취약제 등을 이용하여 산소에 대한 뇌대사율을 관류지수를 증가시켜야 하겠다. Postoperative brain damage is one of most serious complications of cardiopulmonary bypass (CPB). To prevent brain damage during CPB, adequate cerebral perfusion for cerebral oxygen demand should be maintained. This study monitored jugular venous oxyhemoglobin saturation (SjO₂), which reflects the overall balance of cerebral oxygen supply and demand, intermittently in 10 patients undergoing cardiac surgery. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, SjO₂did not change, and it was stable during the hypothermic period of CPB. But a significan reduction in SjO₂was observed during the rewarming period, and SjO₂had an inverse linear correlation with esophageal temperature. Furthermore, the percent decrease of SjO₂was related to rewarming speed. Therefore, therapeutic approaches for SjO₂desaturation include slower rewarming, increasing cerebral blood flow, decreasing the cerebral metabolic rate for oxygen, increasing oxygen content, and increasing perfusion flow rate.
Background: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. Methods : Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. Results : The baseline PaO2, PaCO2, pH, base excess were 318±137 mm Hg, 36±3.5 mm Hg, 7.30±0.06, 6.81±2.65 mmol/l respectively. Hypercarbia and hypoxemia(76±33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload(PCWP and CVP) were increased early in the time course(P<0.05). In contrast, indices of afterload(SVR) increased later, just before cardiac decompensation began(P<0.05). No significant reduction of cardiac output, oxygen delivery, extractd consumption was detected just until abrupt cardiac decompensation started, 5 minute. Conclusions : These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload. (Korean J Anesthesiol 1997; 33: 1020∼1028)
Background: Propofol has an antioxidant capacity and can be used for ischemia-reperfusion injury of the liver. However, the effects of propofol on the Kupffer cells have not been establisked. Methods: Kupffer cells were isolated and cultured from male Sprague-Dawley rats. The effects of propofol on the Kupffer cells were evaluated by a phagocytosis assay, TNF-α gene expression, and superoxide anion release after administering propofol in different concentrations on the cultured Kuprrer cells. Results: The latex bead phagocytosis by the Kupffer cells was suppressed when the Kupffer cells were exposed to propofol irrespective of concentrations. Higher propofol concentrations decreased the loss of Kupffer cells after latex bead phagocytosis. Propofol induced TNF-α mRNA expression in the Kupffer cells, but the mRNA expression level after 50㎍/ml of propofol decreased. The pattern of TNF-α mRNA expression induced by propofol was different to that induced by LPS: TNF-α mRNA was expressed continuously in the propofol-treated cells until 16 hours after exposure to propofol, whereas the level of TNF-α mRNA expression induced by LPS was evident after 2 hours and was not found thereafter. TNF-α production after propofol treatment was not higher than that of the control. Formazan presipitation did not show any qualitative differences between cells untreated or treated with propofol concentrations of 0.5, 5.0, and 50 ㎍/ml. Conclusions: These results showed that propofol might inhibit Kupffer cells. This suggests that propofol and be used for patients with ischemia-reperfusion injury of the liver. (Korean J Anesthesiol 2002; 43: 475~484)
The use of magnesium sulphate has recently increased in anesthesiology and pain medicine. The roles of magnesium sulphate are as an analgesic adjuvant, a vasodilator, a calcium channel blocker and reducing the anesthetic requirement. These effect are primarily based on the regulation of calcium influx into the cell and antagonism of the N-methyl-D-aspartate receptor. We discuss here the clinical effects of magnesium sulphate on anesthesiology and pain medicine.
Jehovah's Witnesses refuse a transfusion of blood or blood products because of religious beliefs; this refusal at times presents a dilemma for the treating physician. We report a case of a 25-year-old Jehovah's Witness patient who underwent a reoperation for a previous proximal humerus shaft fracture and experienced unexpected massive hemorrhage intraoperatively and postoperatively. The postoperative lowest hemoglobin level was 2.9 g/dl. The patient recovered from the severe anemia without any clinical sequala. We review the legal, ethical and religious issues and suggest the best possible medical care that Jehovah's Witness patient would permit.
A 78-year-old female patient was undergone general anesthesia for total abdominal hysterectomy with bilateral salpingo-oopherectomy. Arterial blood pressure dropped 20 minutes after beginning of the surgery when uterine manipulation was started. From then, excessive sweating was found in the face and whole body and core temperature decreased to 34.3oC. Sweating and low body temperature were sustained despite of various aggressive warming efforts. Anticholinergic medication immediately put an end to an hour of excessive sweating and prevented further body temperature decline. Several possibilities of excessive sweating were discussed in this case: uterine manipulation during the light plane of general anesthesia, age related autonomic changes, use of intraoperative opioid and antihypertensive medications.