[show abstract][hide abstract] ABSTRACT: Previous studies have reported a high incidence of acute kidney injury (AKI) after thoracic aortic surgery in heterogeneous patient cohorts, including various aortic diseases and the use of deep hypothermic circulatory arrest. Moderate hypothermia with cerebral perfusion makes deep hypothermia nonessential, but can make end organs susceptible to ischemia during circulatory arrest. We investigated the incidence and risk factors of AKI after thoracic aortic surgery with and without moderate hypothermic circulatory arrest for acute dissection.
We reviewed the medical records of 98 patients undergoing graft replacement of the thoracic aorta for acute dissection between 2008 and 2011 at a university hospital. Acute kidney injury was defined by RIFLE criteria, which is based on serum creatinine or glomerular filtration rate.
The mean age was 55±15 years. The surgical procedures, 96% of which were emergencies, involved the ascending aorta (67%), aortic arch (41%), descending aorta (41%), and aortic valve (5%). Moderate hypothermic circulatory arrest was performed in 75%. The overall incidence of AKI was 54%, and 11% of 98 patients required renal replacement therapy. Thirty-day mortality increased with AKI severity (p=0.002). Independent risk factors for AKI were long cardiopulmonary bypass duration (>180 minutes; odds ratio, 7.50; p=0.008) and preoperative serum creatinine level (odds ratio, 8.43; p=0.016).
Acute kidney injury was common after thoracic aortic surgery for acute dissection with or without moderate hypothermic circulatory arrest and worsened 30-day mortality. Prolonged cardiopulmonary bypass and increased preoperative serum creatinine were independent risk factors for AKI, but moderate hypothermic circulatory arrest was not.
The Annals of thoracic surgery 06/2012; 94(3):766-71. · 3.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: Stress-induced cardiomyopathy (SICM) presenting as an acute myocardial dysfunction is characterized by transient left ventricular wall motion abnormality, which has been known to be associated with excessive catecholamine production caused due to various types of stress. Sympathetic hyperactivity is common during the perioperative period, and reports of SICM occurring during this period have actually increased. We present a case of SICM following negative pressure pulmonary edema due to upper airway obstruction during emergence from anesthesia. Excessive catecholamine release in response to respiratory difficulty could have been the underlying inciting factor.
Korean journal of anesthesiology 01/2012; 62(1):79-82.
[show abstract][hide abstract] ABSTRACT: Suspension laryngoscopy under general anaesthesia with a tracheal tube has been widely used for laryngeal microsurgery, but it has some limitations such as intense cardiovascular stimulation during anaesthesia of short duration, occasionally a poor surgical field, and the possibility of a mass being hampered by the tracheal tube. The aim of this study was to compare the usefulness of the laryngeal mask airway (LMA) Fastrach and fibreoptic bronchoscope with a conventional suspension laryngoscope in laryngeal microsurgery.
Forty patients scheduled for laryngeal microsurgery were enrolled in this prospective randomized study consecutively. After general anaesthesia was induced, laryngeal microsurgery was performed with a fibreoptic bronchoscope through the LMA Fastrach or conventional suspension laryngoscope. The best view of the surgical field, evaluated by percentage of glottic opening score, was obtained by the up-down manipulations of the LMA Fastrach or repositioning the suspension laryngoscope. Blood pressure and heart rate changes at the baseline, preinsertion, and postinsertion were recorded.
Percentage of glottic opening score of the LMA Fastrach group was 100 and that of the suspension laryngoscope group was 80 (P < 0.05). The LMA Fastrach insertion was performed without remarkable systolic or diastolic blood pressure or heart rate changes, but systolic, diastolic blood pressure or heart rate were increased after intubation in the suspension laryngoscope group.
The LMA Fastrach during fibreoptic bronchoscope-guided laryngeal surgery provided a good surgical field and haemodynamic stability without additional risk compared with the conventional suspension laryngoscope.
European Journal of Anaesthesiology 09/2009; 27(1):20-3. · 2.79 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was designed to evaluate the effect of target controlled infusion of propofol on QTc interval and tracheal intubation. Twenty-five unpremedicated, ASA class I or II patients were selected and target concentration infusion of propofol at 5 microg x ml(-1) was used throughout the study. The QTc interval was measured before anaesthetic induction (baseline, T1), 10 min after propofol infusion (T2), immediately after tracheal intubation (T3), and 1 min after tracheal intubation (T4). The QTc interval increased significantly at 10 min after the propofol infusion started compared to baseline (p = 0.003). After tracheal intubation, the QTc interval was further increased when compared to that at T2 (p < 0.0001). The increased QTc interval was within normal limit and no patient had an arrhythmia. In conclusion, although statistically significant, the increase in QTc interval was too small to be clinically significant during propofol infusion. However, the combination of propofol and tracheal intubation must be used carefully in patients with prolonged QTc interval.
[show abstract][hide abstract] ABSTRACT: Prolongation of the corrected QT (QTc) interval is associated with various anaesthetic drugs. The QTc prolongation may become more exacerbated during laryngoscopy and intubation, which is possibly caused by sympathetic stimulation. The aim of this study was to investigate the effects of fentanyl on the QTc interval during propofol induction in healthy patients. The patients were randomly allocated to receive either fentanyl (n = 25) or saline (n = 25) before induction. The QTc interval was significantly prolonged immediately after intubation in control group compared to preceding values, but it did not change in the fentanyl group. The number of patients with the prolonged QTc interval exceeding 20 ms immediately after intubation compared to the baseline values was 14 in the control group and seven in the fentanyl group. In conclusion, pretreatment with fentanyl 2 microg x kg(-1) significantly attenuated QTc prolongation associated with laryngoscopy and tracheal intubation during propofol induction.
[show abstract][hide abstract] ABSTRACT: Stimulation of the sympathetic nervous system associated with tracheal intubation causes corrected QT (QTc) interval prolongation. We postulated that the use of remifentanil during induction of anaesthesia might prevent this. Sixty unpremedicated, ASA grade 1 patients were selected and randomly allocated to receive either saline (group S), remifentanil 0.5 microg x kg(-1) (group R 0.5) or remifentanil 1.0 microg x kg(-1) (group R1.0) 1 min before laryngoscopy. The QTc interval was significantly prolonged immediately following intubation in group S and group R0.5, but it remained stable in group R1.0, compared with the QTc interval just before laryngoscopy. It is concluded that the administration of remifentanil 1.0 microg x kg(-1) before intubation can prevent the prolongation of the QTc interval associated with tracheal intubation during induction of anaesthesia with sevoflurane.
[show abstract][hide abstract] ABSTRACT: We performed a randomised, crossover study in 38 anaesthetised and paralysed patients to compare the performance of the CobraPLA and the LMA Classic during controlled ventilation. The median (IQR [range]) airway leak pressure was 23.0 (20-24 [12-30]) cmH(2)O for the CobraPLA and 15.0 (12-19 [8-30]) cmH(2)O for the LMA Classic (p < 0.001). The median (IQR [range]) insertion time was 15.0 (11-26 [9-31]) s for the CobraPLA and 22.5 (20-25 [15-50]) s for the LMA Classic (p < 0.001). There was no significant difference between the two devices for the number of insertion and reposition attempts, the anatomical position scored by fibreoptic bronchoscopy or the peak and plateau airway pressures. There were no adverse events during anaesthesia. The CobraPLA provides a better airway leak pressure and takes less time to insert than the LMA Classic in paralysed patients. Our data show that the CobraPLA can be used to secure a patent airway during controlled ventilation in selected patients.
[show abstract][hide abstract] ABSTRACT: We report a 66-yr-old male patient who developed tricuspid regurgitation secondary to internal cardiac massage. After uneventful off-pump coronary artery bypass surgery, the subject experienced cardiac arrest in the intensive care unit. External cardiac massage was initiated and internal cardiac massage was performed eventually. A transesophageal echocardiography revealed avulsion of the anterior papillary muscle and chordae to the anterior leaflet after successful cardiopulmonary resuscitation. Emergency repair of the papillary muscle was performed under cardiopulmonary bypass.
Journal of Korean Medical Science 09/2007; 22(4):731-4. · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: The CobraPLA (CPLA) is a relatively new supraglottic airway device that has not been sufficiently investigated. Here, we performed a prospective observational study to evaluate the efficacy of the CPLA during controlled ventilation. In 50 anesthetized and paralyzed patients undergoing elective surgery a CPLA was inserted and inflated to an intracuff pressure of 60 cm H2O. The success rate of insertion upon the first attempt was 82% (41/50), with a mean insertion time of 16.3 +/- 4.5 seconds. The adequacy of ventilation was assessed by observing the end tidal CO2 waveform, movement of the chest wall, peak airway pressure (13.5 cm H2O), and leak fraction (4%). We documented the airway sealing pressure (22.5 cm H2O) and noted that the the site of gas leaks at that pressure were either at the neck (52%), the abdomen (46%), or both (2%). In 44 (88%) patients, the vocal cords were visible in the fiberoptic view through the CPLA. There was no gastric insufflation during the anesthesia. Respiratory and hemodynamic parameters remained stable during CPLA insertion. Postoperative blood staining of CPLA was minimal, occurring in 22% (11/50) of patients. Mild and moderate throat soreness was reported in 44% (22/50) and 4% (2/50) of patients, respectively. Lastly, mild dysphonia was observed in 6% (3/50) of patients and mild dysphagia in 10% (5/50) of patients. Our results indicated that the CPLA is both easy to place and allows adequate ventilation during controlled ventilation.
Yonsei Medical Journal 01/2007; 47(6):799-804. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Chronic treatment with renin-angiotensin system (RAS) antagonists frequently causes deleterious hypotension during anaesthesia. We compared the effects of angiotensin II receptor antagonists (ARA) and angiotensin-converting enzyme inhibitors (ACEI) on neurohormonal levels and haemodynamics during cardiopulmonary bypass (CPB).
Forty-four patients undergoing mitral valvular surgery who were treated with either ARA (ARA group, n=14) or ACEI (ACEI group, n=15) over 12 weeks or who were not treated with any RAS antagonist (control group, n=15) were enrolled. The plasma levels of epinephrine, norepinephrine, arginine vasopressin (AVP) and angiotensin II, and haemodynamic variables were measured before (T1) and 15 min after (T2) the start of CPB, before aortic unclamping (T3) and at skin closure (T4). Mean arterial pressure (MAP) was maintained above 60 mm Hg with phenylephrine administration during CPB.
The plasma epinephrine, norepinephrine, AVP and angiotensin II levels increased during CPB in all groups. Compared with the control group, the AVP level was lower at T1 in the ARA group and at T2 in the ARA and ACEI groups. The angiotensin II level was higher at T1, T2 and T3 in ARA group compared with ACEI and control groups. There were no significant differences in the epinephrine and norepinephrine levels among the three groups. The amount of administered phenylephrine during CPB was greater and MAP was lower in the ARA group compared with the ACEI and control groups.
Chronic ARA treatment resulted in more profound hypotension than ACEI treatment during CPB, and this may be associated with the blockade of angiotensin II receptors by ARA.
BJA British Journal of Anaesthesia 01/2007; 97(6):792-8. · 4.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: This randomized, double-blind, placebo-controlled study was designed to determine whether an intra-operative, intravenous infusion of glucose-insulin-potassium (GIK) could be helpful in the prevention of myocardial ischemia and in the maintenance of intra-operative cardiac performance in patients undergoing off-pump coronary artery bypass (OP-CAB) surgery.
Eighty two adults undergoing elective OP-CAB surgery were randomly divided into two groups that received intravenously either 5% dextrose in water or GIK (50% dextrose in 500 ml of water; regular insulin, 125 IU; potassium, 80 mmol) at 0.75 ml/kg/h immediately before the induction of anesthesia to the end of surgery. To evaluate myocardial damage, creatine kinase MB and troponin T were measured before surgery, immediately after arrival in the intensive care unit and on the first post-operative day. To assess cardiac performance, hemodynamic data were obtained before and after the induction of anesthesia, before and after the bypass graft and after sternal closure. Blood glucose was measured at the same time.
There was no significant difference in cardiac enzymes, hemodynamic parameters and blood glucose between the two groups. The use of vasoactive, inotropic and/or anti-arrhythmic agents, insulin and supplemental glucose was not significantly different between the groups.
The results suggest that the intravenous administration of GIK during OP-CAB surgery neither reduces myocardial damage nor improves intra-operative cardiac performance in patients without contractile dysfunction.
[show abstract][hide abstract] ABSTRACT: The effects of pre-operative angiotensin-converting enzyme inhibitor (ACEI) treatment on haemodynamic status and vasoconstrictor requirements during off-pump coronary artery bypass surgery (OPCAB) were studied. Eighty patients selected for OPCAB were divided into those who had been treated with ACEIs for 4 weeks or more pre-operatively (ACEI group) (n = 43) and those who had not been treated with ACEIs (control group) (n = 37). Noradrenaline was infused during the operation when the mean systemic arterial pressure (SAP) fell below 60 mmHg. No significant differences in the haemodynamic parameters measured were detected between the two groups, except for cardiac output, which was found to be significantly greater in the control group. During anastomosis of the obtuse marginal branch of the left circumflex artery (OM), a significantly larger amount of noradrenaline was required by the ACEI group compared with the control group. In conclusion, pre-operative treatment with ACEIs significantly increased the amount of vasoconstrictor necessary to maintain the target SAP during OM anastomosis during OPCAB.
The Journal of international medical research 11/2005; 33(6):693-702. · 0.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: The Laryngeal Tube (LT), (VBM Medizintechnik, Sulz, Germany) is a relatively new supraglottic device for controlling the airway. Arterial carbon dioxide tension (PaCO(2)) can be estimated by monitoring the end-tidal tension of carbon dioxide (PETCO(2)). The relationship between PETCO(2) and PaCO(2) during controlled ventilation via the LT has not been reported.
During general anesthesia, 45 patients were mechanically ventilated using an LT. PETCO(2) and PaCO(2) were measured once PETCO(2) had reached a steady state. The LT was then removed and the trachea intubated using an endotracheal tube (ETT), and the identical ventilatory variables were resumed. Following stabilization, PETCO(2) was again determined and PaCO(2) estimated.
The mean PETCO(2) and PaCO(2) values were 4.43 +/- 0.26 kPa and 4.67 +/- 0.32 kPa, respectively, during LT ventilation, and 4.36 +/- 0.23 kPa and 4.61 +/- 0.26 kPa, respectively, during ETT ventilation. Analysis of differences between the PETCO(2) and PaCO(2) values using the Bland and Altman method revealed a bias +/- precision of 0.24 +/- 0.15 kPa for LT and 0.27 +/- 0.15 kPa for ETT. The root mean square error was 0.28 for the LT and 0.30 for the ETT.
This study suggests that for healthy adult patients mechanically ventilated via the LT, the PETCO(2) value reflects the PaCO(2) value as closely as when patients are ETT ventilated, allowing capnometry to be used to evaluate the adequacy of ventilation.