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ABSTRACT: "Cardiac and respiratory oscillations have been shown to interact with each other. This interaction could reflect autonomic nervous system functionality. Propofol-induced yawning during anesthesia induction seems to be associated with sympathetic activation. Presumptively, there is high linearity among interaction of different physiologic system behaviors. Recently, investigators used coherence analysis to quantify the existence and strength of linearity between system signals for study of cardio-respiratory interaction under different physiological conditions. In this investigation, we used a method of time-frequency coherence function to analyze ECG and respiration signals to investigate the linearity of cardio-respiratory dynamics in patients undergoing routine propofol induction procedures for elective surgery. In this prospective, observational clinical study, a total of 84 eligible patients were enrolled. The patients were categorized into yawning and no-yawning groups during propofol induction. During induction, both groups demonstrated significant reduction in high frequency coherence (coh-HF) with simultaneously significant increase in very low frequency coherence (coh-VLF) compared to the pre-induction period. As yawning occurred, the yawning group had more significant changes of cardio-respiratory coherences than the no-yawning group at coh-LF and coh-VLF bands. The yawning group also showed loss of linearity at high frequency band (coh-HF > 0.5) as compared with the pre-induction period, and also showed increases in linearity at low (coh-LF > 0.5) and very low (coh-VLF > 0.5) frequency bands compared with the no-yawning group. Propofol-induced yawning alters cardio-respiratory dynamics with changes of linearity between cardio-vascular and respiratory system behaviors."
The Chinese journal of physiology 06/2012; 55(3):169-77. · 0.56 Impact Factor
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ABSTRACT: Pulmonary vein (PV) sleeves, composed of cardiomyocytes, play certain roles in arrhythmogenesis. In the literature, it has been frequently reported that PV sleeves possess intrinsic spontaneous pacemaking activity and triggered activity in normal dogs and rabbits. In contrast, other research groups presented totally opposite findings which showed absence of such pacemakers in dogs, rabbits and rats. The present study was designed to clarify this puzzle and contradiction.
A novel methodology using in vitro experimentation was used to examine the electromechanical activity of whole segments of PV sleeves. The ring preparation was composed of a small piece of left atrial (LA) free wall, PV ostium and sleeve from rabbits. A circumferential contraction of the PV sleeve was measured when the preparation was electrically driven from the LA free wall. Mechanical force of the ring preparation was measured using a force transducer. The action potentials were recorded using conventional intracellular recording technique in strip preparation.
In 15 rabbits, no spontaneous pacemaking activity or triggered activity was found in the in vitro ring preparation of PV sleeve. The circumferential contraction of PV sleeves was external calcium-dependent. Frequency-force relation displayed a negative staircase at 0.1-0.5 Hz and a positive staircase at 1-5 Hz. Post-rest potentiation was prominent between 15 s and 120 s. Intracellular action potential recording did not display any automaticity or triggered activity in PV sleeves.
In an intact ring preparation of rabbit PV sleeves, intrinsic spontaneous pacemaking activity or triggered activity was not found.
Journal of the Chinese Medical Association 01/2009; 71(12):610-8. · 0.79 Impact Factor
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ABSTRACT: To investigate the proportion of propofol-induced yawning and sympathovagal balance during propofol-induced yawning.
Prospective, observational, clinical study.
University hospital and 2400-bed tertiary medical center.
546 ASA physical status I and II patients undergoing elective surgery with general anesthesia.
Standard induction of anesthesia was performed with intravenous (IV) propofol two to four mg/kg (group P), or pretreatment with atropine 0.1 mg/kg (group AP) or with fentanyl 1 to 3 microg/kg (group FP) before propofol. Continuous standard electrocardiogram for heart rate variability (HRV) was performed in another 20 patients to investigate sympathovagal balance during propofol-induced yawning.
The proportions of yawning were 53.5% (207/386), 61.1% (55/90), and 0% (0/50) in the P, AP, and FP groups, respectively. Propofol-induced yawning could be dramatically decreased by pretreatment with IV fentanyl (P < 0.001, chi2 test). Significant increased ratio of low-frequency/high-frequency power was detected during HRV monitoring in 9 patients with yawning in comparison with 11 patients without yawning (P < 0.05, Wilcoxon signed-rank test).
Pretreatment with fentanyl may inhibit propofol-induced yawning. Fluctuations in autonomic function have been noted during propofol-induced yawning.
Journal of Clinical Anesthesia 02/2008; 20(1):25-9. · 1.21 Impact Factor
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ABSTRACT: Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.
Journal of the Chinese Medical Association 11/2007; 70(10):456-9. · 0.79 Impact Factor
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ABSTRACT: A 90-year-old female patient undergoing surgery for knee and hip fractures under general anesthesia sustained cardiac arrest intraoperatively. The transesophageal echocardiography performed during resuscitation revealed massive pulmonary embolism with a 2 x 3 cm oval-shaped thrombus in the bifurcation of pulmonary artery. Anticoagulant therapy was administered immediately. Clinical symptoms were gradually improved, and transthoracic echocardiography performed 5 days later revealed no evidence of residual thromboemboli. Subsequently the patient developed liver and acute renal failures in consequence of hypoperfusion during the intraoperative resuscitation, and died of multiple organ failure 21 days after the procedure. We conclude that transesophageal echocardiography is a useful diagnostic instrument and should be utilized in high risk patient as early as possible, even before and during surgery.
Acta Anaesthesiologica Taiwanica 07/2007; 45(2):117-20.
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ABSTRACT: Acute intermittent porphyria (AIP) is an inherited metabolic disorder caused by deficiency of porphobilinogen deaminase, an enzyme found in the synthetic pathway of heme. Acute attack of AIP may be precipitated by many factors during operation and anesthesia, including fasting, dehydration, stress, infection, and drugs. Acute attack of AIP is likely fatal. Therefore, the drugs recommended as being safe in anesthesia for porphyria patients are up-to-dately refreshed and renovated and the identification of whether a drug is safe or not is based on cumulative anecdotal experiences. Here, we report the safe use of rocuronium and sevoflurane for long exposure in a patient affected with acute intermittent porphyria.
Acta Anaesthesiologica Taiwanica 10/2006; 44(3):169-71.
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ABSTRACT: Pulmonary embolism is not uncommonly encountered in orthopedic patients with high risks, such as prolonged immobility, obesity, past or family history of thromboembolism, pelvic and long bone fractures. Here we report a young male patient with a residual cerebral arteriovenous malformation post-craniotomy suffered from acute severe hypoxemia after sustaining a simple fracture of the left femur shaft from a motorcycle accident. The emergent surgery was deferred in view of suspectable pulmonary embolism. Under supportive treatment, the condition spontaneously resolved, and the surgery was later performed uneventfully. To the best of our knowledge, this was the first instance that a pulmonary embolism (suspected subacute fat embolism syndrome) which ran in a natural course to spontaneous resolution was observed. We would like to report our clinical observation, and discuss the principle of anesthetic management in the text.
Acta Anaesthesiologica Taiwanica 04/2006; 44(1):47-50.
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International Journal of Cardiology 04/2006; 107(3):417-8. · 7.08 Impact Factor
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Canadian Journal of Anaesthesia 12/2005; 52(9):1002-3. · 2.35 Impact Factor
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ABSTRACT: To study the cellular mechanisms governing cardiac atrial arrhythmias initiated by ectopic focus (or foci) from pulmonary veins (PVs).
In the present in vitro study, we applied the conventional microelectrode technique to record intracellular action potentials in PV sleeves from dogs.
In 80 normal healthy dogs, all action potentials recorded in cardiomyocytes from PV sleeves were fast-response. The pharmacological responses to quinidine, nisoldipine, D-sotalol, 4-aminopyridine, isoproterenol, acetylcholine, and adenosine were characteristic of those in atrial cells. Diastolic depolarization and spontaneous activity could be induced by 1 mmol/L Ba2+ in all the 22 PV specimens being tested, but only in 3 of 11 of left atrial specimens (p<0.0001). In the presence of 1 mmol/L Ba2+, the diastolic slope was only slightly affected by Ni2+ (500 micromol/L), but was significantly suppressed by Cd2+ (200 micromol/L). Ryanodine (2 micromol/L) caused a transient increase, followed by a marked decrease of Ba2+-induced spontaneous activity. Isoproterenol shortened and acetylcholine prolonged the cycle length of the Ba2+-induced automatic activity. In the presence of isoproterenol, washout of acetylcholine induced a rebound phenomenon, which triggered a short period of spontaneous activity. The results suggest an important role of intracellular cytoplasmic Ca2+ loading. Under conditions that mimic ischemia/hypoxia, the resting membrane potential depolarized, upstroke of the action potential became depressed and the action potential duration shortened. In the presence of isoproterenol and elevated external K+, spontaneous activity was generated.
These findings indicate a lack of arrhythmogenic activity in normal healthy PV sleeves. Abnormal automaticity and triggered activity occurred exclusively under simulated pathologic conditions. Ba2+-induced automaticity was more easily induced in PV than in the left atrium. The same conditions might also favor the genesis of reentry in the in vivo condition.
International Journal of Cardiology 10/2005; 104(1):59-66. · 7.08 Impact Factor
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ABSTRACT: To define the depth of the thoracic epidural space in the paramedian axis.
Retrospective study.
Operating room of a tertiary care medical center.
Nine hundred ninety-eight consecutive adults scheduled for elective major cardiothoracic/abdominal surgery and postoperative thoracic epidural pain control.
The thoracic epidural pain control was accomplished via paramedian approach at indicated levels in 977 of 998 patients with uniform and well-standardized technique routinely performed in this institute.
The depth of the epidural space, defined as the distance from the needle tip just penetrating the epidural layer to the overlying skin, was measured by directly checking the length markers displayed on the needle. Association between demographic variables and epidural depths at different thoracic levels was analyzed.
The mean thoracic epidural depth was (mean+/-SD) 5.11+/-0.94 cm, which was positively correlated with the body weight (regression coefficient=0.039, P<.001) and body mass index but was unrelated to sex, age, or body height. On stepwise linear multivariate regression analysis, each 10 kg of increase in body weight would result in a 0.39-cm increase in the depth. Besides, this paramedian depth was 0.34 cm longer at upper thoracic levels (T9 and upper) than that at lower levels (T10 and lower, P<.001).
Body weight, body mass index, and anatomical levels determine the paramedian thoracic epidural depth. The greater the patient's weight and the higher the puncture level, the deeper the thoracic epidural space from the body surface.
Journal of Clinical Anesthesia 08/2005; 17(5):339-43. · 1.21 Impact Factor
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ABSTRACT: Forehead lift plastic surgery is regarded as a rather safe operation without serious cardiovascular complications. Although cardiac arrhythmias (e.g., sinus bradycardia) during such an esthetically plastic surgery have been sporadically reported in literature, repetitive junctional rhythm has not ever been recounted. In this case report, we present a 45-year-old woman who developed repetitive junctional rhythm during forehead lift plastic surgery. The possible offenders causative of the arrhythmia (e.g., oculocardiac reflex induced by repeated surgical manipulation) and the principle of perioperative management were discussed in the text.
Acta Anaesthesiologica Taiwanica 07/2005; 43(2):109-12.
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Chia-Jung Huang,
Chao-Long Chen,
Chia-Chi Tseng, Hsiang-Ning Luk,
Vanessa De Villa,
Chih-Shien Wang,
Yaw-Sen Chen,
Chih-Chi Wang,
Yu-Fan Cheng,
Tung-Liang Huang,
King-Wah Chiu,
Shir-Hor Wang,
Chih-Che Lin,
Tsan-Shiun Lin,
Yueh-Wei Liu,
Bruno Jawan
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ABSTRACT: Hypothermia is common during surgery in regular operating room (OR) temperature. The effect of increasing the OR temperature to 24 degrees C coupled with simple warming measures to maintain normothermia in both pediatric and adult patients during living donor liver transplantation (LDLT) was evaluated. One hundred patients undergoing LDLT were separated into pediatric (GI) and adult (GII) groups. Nasopharyngeal temperature (NT) at each hour for the first 6 h, at the time of anhepatic phase, 5 and 30 min after reperfusion, and each hour for the last 2 h of the operation was recorded, compared and analyzed. A significant difference in core temperature variation was noted between the two groups. GI tended to be hyperthermic, while GII remained mildly hypothermic throughout the procedure. A sudden decrease of NT was observed in both groups during the anhepatic and reperfusion phases. Correlation between liver graft weight over recipient body weight ratio rather than the graft weight itself was found in GI, but no such correlation was found in GII. OR temperature of 24 degrees C, together with simple active and passive warming measures are more effective in maintaining normothermia during liver transplantation in pediatric patients than in adults.
Transplant International 05/2005; 18(4):396-400. · 2.92 Impact Factor
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ABSTRACT: During urgent cardiopulmonary bypass for acute myocardial infarction, a pulmonary artery (PA) catheter was inserted in an 81-year-old male patient for monitoring of cardiopulmonary function. The presence of the PA catheter in the right pericardium was noted by the cardiothoracic surgeon during surgery. In retrospect, the malposition of the catheter in the pericardium could be clearly seen in the routine intraoperative transesophageal echocardiogram. The presence of a PA pressure waveform and the ability to measure cardiac output and mixed venous oxygen saturation from the PA catheter does not exclude the possibility that it could still be perforating the right ventricle.
Journal of Clinical Anesthesia 04/2005; 17(2):124-7. · 1.21 Impact Factor
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International Journal of Cardiology 12/2004; 97(2):303-4. · 7.08 Impact Factor
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Canadian Journal of Anaesthesia 11/2004; 51(8):856-7. · 2.35 Impact Factor
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ABSTRACT: Background : Naloxone is a morphine antagonist usually given to reverse or to prevent the respiratory depression induced by morphine overdose. Case presentation : A 61-year-old man underwent a lower abdominal resection for rectal carcinoma. Epidural morphine 2 mg diluted in 10 ml of normal saline was prescribed. Twenty milligrams of morphine instead of 2 mg morphine were given by mistake. The patient was intensively observed in the post-anaesthetic room without giving naloxone for 40 hours. The respiratory rate and arterial blood gases were monitored. The respiratory rate was mildly depressed (below 16 breaths/min) for as long as 20 hours. The peak of the respiratory depression was observed after 2?3 hours with a respiratory rate of 12 breaths per minute and PaCO2 of 56.3 mmHg. The patient was almost 40 hours pain free. No nausea, vomiting and pruritus was noted, but urine retention was observed for 26 days.
The Pain Clinic 07/2004; 16(3):359-362.
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Anesthesiology 07/2004; 100(6):1630-1. · 5.36 Impact Factor
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Bruno Jawan,
Vanessa de Villa, Hsiang-Ning Luk,
Chih-Shien Wang,
Chia-Jung Huang,
Yaw-Sen Chen,
Chih-Chi Wang,
Yu-Fan Cheng,
Tung-Liang Huang,
Hock-Liew Eng,
Po-Ping Liu,
King-Wah Chiu,
Chao-Long Chen
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ABSTRACT: Perioperative normovolemic anemia was applied in pediatric living-donor liver transplant (LDLT) recipients with the aim of reducing the use of blood products and decreasing transfusion-related risk.
The anemic state was allowed to occur by replacing intraoperative blood and transudate loss with colloid solutions and a discriminate use of packed red blood cells. When blood transfusion was required, the amount of blood replacement was calculated to target a hemoglobin level not higher than 8 to 9 g/dL.
Forty-eight pediatric patients underwent LDLT. Their mean hemoglobin and hematocrit levels were maintained below 9 g/dL and 27%, respectively, at the end of the operation, at the time of extubation, postoperative days 3, 10, and 20, and at the time of discharge. The mean ventilatory support time was 15.7 hr, and no patient required reintubation. Graft function normalized within the first week posttransplant in all patients, and there was no documented case of acute hepatic artery thrombosis. All the patients were discharged with acceptable liver function, and 98% of them remain alive to date.
Routine application of perioperative normovolemic anemia in pediatric LDLT has allowed the sparing use of blood products. Approximately half of our patients (42%) did not require intraoperative blood transfusion; 31% of the patients went home without receiving any blood products except 5% albumin. There were no adverse effects with this maneuver, and graft function was good in all patients.
Transplantation 06/2004; 77(9):1394-8. · 4.00 Impact Factor
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ABSTRACT: Myocardial swelling occurs during endotoxic shock. The hypothesis that swelling-activated Cl- current (ICl,swell) activates during endotoxic shock was tested.
Endotoxic shock was induced by intravenous lipopolysaccharides (10 mg/kg) in guinea pigs. The effects of ICl,swell blockers on the cardiac action potentials in papillary muscles and on the ICl,swell in single ventricular myocytes were tested.
Action potential duration (APD) at 90% of repolarization (APD90) was significantly shortened after 5-h endotoxic shock in guinea pig papillary muscles. I(Cl,swell) blockers, 9-anthracene carboxylic acid (9-AC) and 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS), dose-dependently prolonged the shortened APD90. Inducible nitric oxide synthase (iNOS) inhibitors, L-N6-(1-iminoethyl) lysine (L-NIL) and N-[[3-(aminomethyl)phenyl]methyl]-ethanimidamide (1400 W), also prolonged the APD90. Protein kinase C (PKC) activators, 4beta-phorbol 12-myristate 13-acetate (PMA) and phorbol 12,13-didecanoate (PDD), also prolonged the APD. The addition of glibenclamide (an ATP-sensitive K+ channel blocker) on top of these ICl,swell blockers hastened the recovery of APD90 compared to the use of ICl,swell blockers alone. Whole-cell voltage-clamp study in single ventricular myocytes from endotoxic shock heart disclosed activation of a DIDS- and 9-AC-sensitive current. These currents displayed outward rectification with reversal potentials similar to the calculated Nernst potential for Cl-. The reversal potentials tracked the ECl closely when the Cl- gradient was changed, suggesting that Cl- was the major charged carrier.
We have shown for the first time that ICl,swell activates in guinea pig heart in endotoxic shock. The change in this membrane current, together with the activation of ATP-sensitive K+ current, contributes to the electrophysiological derangement in endotoxic shock.
Cardiovascular Research 05/2004; 62(1):96-104. · 6.06 Impact Factor
