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Jieun Song,
Jungmin Park,
Jee-Young Kim,
Joo-Duck Kim,
Woon-Seok Kang,
Hasmizy Bin Muhammad,
Mi-Young Kwon,
Seong-Hyop Kim,
Tae Gyoon Yoon, Tae-Yop Kim,
Jin Woo Chung
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ABSTRACT: This study evaluated the efficacy of ulinastatin for attenuating organ injury and the release of proinflammatory cytokines due to cardiopulmonary bypass (CPB) during cardiac surgery.
Patients undergoing valvular heart surgery employing CPB were assigned to receive either ulinastatin (group U, n = 13) or a placebo (group C, n = 11) before the commencement of CPB. Hemodynamic data, parameters of major organ injury and function, and proinflammatory cytokines were measured after the induction of anesthesia (T1), after CPB (T2), at the end of anesthesia (T3), and at 24 hours after surgery (POD).
The demographic data, CPB duration, and perioperative transfusions were not different between the groups. PaO2/FiO2 in group U was significantly higher than that in group C at T3 (3.8 ± 0.8 vs. 2.8 ± 0.7, P = 0.005) and at POD (4.0 ± 0.7 vs. 2.8 ± 0.7, P < 0.001). Creatine kinase-MB at POD in group U was significantly lower than that in group C (17.7 ± 8.3 vs. 33.7 ± 22.1, P = 0.03), whereas troponin I at POD was not different between the groups. Creatinine clearance and the extubation time were not different between the groups at POD. The dopamine infusion rate during the post-CPB period in group U was significantly lower than that in group C (1.6 ± 1.6 vs. 5.5 ± 3.3 µg/kg/min, P = 0.003). The interleukin-6 and tumor necrosis factor-α concentrations at T1, T2, and T3 as well as the incidences of postoperative cardiac, pulmonary and kidney injuries were not different between the groups.
Ulinastatin pretreatment resulted in an improved oxygenation profile and reduced inotropic support, probably by attenuating the degree of cardiopulmonary injury; however, it did not reduce the levels of proinflammatory cytokines.
Korean journal of anesthesiology 04/2013; 64(4):334-40.
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ABSTRACT: BACKGROUND:The effects of maneuvers to increase intrathoracic pressure and of Trendelenburg position on the cross-sectional area (CSA) of the subclavian vein (SCV) and the relationship between the SCV and adjacent structures have not been investigated.METHODS:In ultrasonography-guided SCV catheterization (N = 30), the CSA of the SCV and the distance between the SCV and pleura (DSCV-pleura) were determined during 10-second airway opening, and 10-second positive inspiratory hold with 20 cm H2O in the supine position (S-0, and S-20) and the 10° Trendelenburg position (T-0, and T-20). In addition to a statistical significance of P < 0.05, CSA and DSCV-pleura differences of ≥15% were defined as clinically relevant changes.RESULTS:CSA (mean [95% confidence interval]) in S-20, T-0, and T-20 (1.02 [0.95-1.14] cm2, 1.04 [0.95-1.15] cm2, and 1.14 [1.04-1.24] cm2, respectively) was significantly larger than a CSA in S-0 (0.93 [0.86-1.00] cm2, all P < 0.001). However, only the increase of CSA in T-20 vs S-0 (0.21 cm2, 23.2%) was clinically meaningful (≥15%). The number of patients who showed CSA increase ≥15% was more in S-0 to T-20 (57%) compared with those in S-0 to S-20 (23%) and S-0 to T-0 (27%). DSCV-pleura measurements (mean) in S-20 and T-20 (0.61 and 0.60 cm) were significantly shorter than those in S-0 (0.70 cm, all P < 0.001), but the reductions of DSCV-pleura were not clinically meaningful (≥15%).CONCLUSIONS:The combined application of inspiratory hold and Trendelenburg position provided a greater and more relevant degree of CSA increase without compromising DSCV-pleura, which may facilitate SCV catheterization. Further investigations are needed to determine whether these results affect the success rate of catheterization and the risk of procedural injury.
Anesthesia and analgesia 03/2013; · 3.08 Impact Factor
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ABSTRACT: For patients in the intensive care unit (ICU) or under monitored anesthetic care (MAC), the precise monitoring of sedation depth facilitates the optimization of dosage and prevents adverse complications from underor over-sedation. For this purpose, conventional subjective sedation scales, such as the Observer's Assessment of Alertness/Sedation (OAA/S) or the Ramsay scale, have been widely utilized. Current procedures frequently disturb the patient's comfort and compromise the already well-established sedation. Therefore, reliable objective sedation scales that do not cause disturbances would be beneficial. We aimed to determine whether spectral entropy can be used as a sedation monitor as well as determine its ability to discriminate all levels of propofol-induced sedation during gradual increments of propofol dosage.
In 25 healthy volunteers undergoing general anesthesia, the values of response entropy (RE) and state entropy (SE) corresponding to each OAA/S (5 to 1) were determined. The scores were then analyzed during each 0.5 mcg/ml- incremental increase of a propofol dose.
We observed a reduction of both RE and SE values that correlated with the OAA/S (correlation coefficient of 0.819 in RE-OAA/S and 0.753 in SE-OAA/S). The RE and SE values corresponding to awake (OAA/S score 5), light sedation (OAA/S 3-4) and deep sedation (OAA/S 1-2) displayed differences (P < 0.05).
The results indicate that spectral entropy can be utilized as a reliable objective monitor to determine the depth of propofol-induced sedation.
Korean journal of anesthesiology 03/2012; 62(3):234-9.
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ABSTRACT: Intracardiac thrombus during cardiopulmonary bypass (CPB) with full heparinization is very rare but fatal. A 60-year-old woman was scheduled for aortic and mitral valve repairs with a maze procedure for mixed aortic and mitral valvular heart disease with atrial fibrillation. Preoperative transthoracic echocardiography and cardiac computed tomography showed moderate aortic regurgitation and moderate mitral stenosis with regurgitation. There was no intracardiac thrombus. Aortic and mitral valve repairs with the maze procedure were successfully performed without unexpected events. During CPB weaning, a mobile hyper-echogenic mass in the left atrium was detected on transesophageal echocardiography. After cardiac arrest, it was surgically removed. On completion of the operation, weaning from CPB was accomplished uneventfully. The patient fully recovered and was discharged from the intensive care unit on her third postoperative day.
Korean journal of anesthesiology 02/2012; 62(2):175-8.
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ABSTRACT: The effects of dexmedetomidine on the propofol-sparing effect and intraoperative hemodynamics during remifentanil-based propofol-supplemented anesthesia have not been well investigated.
Twenty patients undergoing breast surgery were randomly allocated to receive dexmedetomidine (group DEX) or placebo (group C). In the DEX group, dexmedetomidine was loaded (1 µg/kg) before anesthesia induction and was infused (0.6 µg/kg/h) during surgery. Anesthesia was induced with a target-controlled infusion (TCI) of propofol (effect site concentration, Ce; 3 µg/ml) and remifentanil (plasma concentration, Cp, 10 ng/ml). The Ce of TCI-propofol was adjusted to a bispectral index of 45-55, and Cp of TCI-remifentanil was fixed at 10 ng/ml in both groups. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at baseline (T-control), after the loading of study drugs (T-loading), 3 min after anesthesia induction (T-induction), tracheal intubation (T-trachea), incision (T-incision), 30 min after incision (T-incision30), and at tracheal extubation (T-extubation). MAP% and HR% (MAP and HR vs. T-control) were determined and the propofol infusion rate was calculated.
The propofol infusion rate was significantly lower in the DEX group than in group C (63.9 ± 16.2 vs. 96.4 ± 10.0 µg/kg/min, respectively; P < 0.001). The changes in MAP% at T-induction, T-trachea and T-incision in group DEX (-10.0 ± 3.9%, -9.4 ± 4.6% and -11.2 ± 6.3%, respectively) were significantly less than those in group C (-27.6 ± 13.9%, -21.7 ± 17.1%, and -25.1 ± 14.1%; P < 0.05, respectively).
Dexmedetomidine reduced the propofol requirement for remifentanil-based anesthesia while producing more stable intraoperative hemodynamics.
Korean journal of anesthesiology 02/2012; 62(2):113-8.
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ABSTRACT: An intraoperative echocardiographic evaluation to determine the feasibility and adequacy of the valve repair procedure is crucial for a successful repair. However, aortic valve repair in severe aortic stenosis (AS) is very limited and, consequently, its intraoperative echocardiographic evaluation has not been described well. Here, we describe an intraoperative transesophageal echocardiographic evaluation of a double-valve repair procedure for a patient with severe AS, moderate aortic insufficiency, and severe mitral stenosis.
Echocardiography 11/2011; 29(2):187-91. · 1.24 Impact Factor
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ABSTRACT: Cardiac surgery through a thoracotomy using one-lung ventilation (OLV) is thought to be associated with worse postoperative pulmonary gas exchange than sternotomy using two-lung ventilation (TLV), but this has not been confirmed yet. We, therefore, compared postoperative pulmonary gas exchange after mitral valve repair between sternotomy (group TLV) and thoracotomy (group OLV).
Randomised controlled study.
University teaching hospital.
Cardiac surgery patients.
Sternotomy or thoracotomy was used for mitral valve repair.
The ratio of arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) was compared in both groups before induction of anaesthesia (T0) and just before departure from the operating room to the ICU (T1). Fluid administration, transfusion requirements and urine output were checked intraoperatively. Postoperative haemoglobin (Hb), haematocrit (Hct) and creatinine were evaluated. Cardiopulmonary bypass (CPB) time, intubation time and ICU stay were also recorded.
The PaO2/FiO2 ratio (mean ± SD) at T1 was significantly lower than at T0 in both groups (326.9 ± 120.1 vs. 431.9 ± 73.7 mmHg in group TLV, P < 0.001; 374.9 ± 130.9 vs. 445.4 ± 73.7 mmHg in group OLV, P = 0.001), but did not differ significantly between the two groups. The doses of inotropes and vaopressors used were not significantly different between the groups. Intraoperative fluid administration, transfusion requirements, urine output and postoperative Hb/Hct and creatinine did not differ significantly between the groups. CPB time, intubation time and ICU stay also did not differ significantly between the groups.
Perioperative pulmonary function following OLV via a thoracotomy was not significantly worse than that following TLV via a sternotomy in mitral valve repair.
Not registered.
European Journal of Anaesthesiology 09/2011; 28(11):807-12. · 2.23 Impact Factor
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ABSTRACT: The authors aimed to investigate whether immediate postoperative hypoalbuminemia could be associated with outcomes after off-pump coronary artery bypass graft (OPCAB) surgery.
A retrospective analysis of the medical data.
Cardiac operating room and adult cardiovascular intensive care unit at a single institution.
Six hundred ninety adult patients underwent elective OPCAB surgery over a 30-month period.
None.
To evaluate the clinical relevance of immediate postoperative hypoalbuminemia, the lowest serum albumin level measured over the first 12 hours postoperatively was recorded. A cutoff point was calculated by the area under the curve in the receiver operating characteristic plot for 30-day adverse events including death. Patients were classified according to the cutoff value, and outcomes were compared between groups using propensity score-matching analysis. The impact of immediate postoperative hypoalbuminemia on OPCAB outcome was investigated using multivariate analysis. The cutoff value for immediate postoperative albumin concentration for predicting 30-day adverse events was 2.3 g/dL. Immediate postoperative hypoalbuminemia (<2.3 g/dL) was associated independently with postoperative respiratory failure (odds ratio [OR] = 8.85, p = 0.04), wound infection (OR = 4.44, p = 0.04), the need for an intra-aortic balloon pump after the operation (OR = 13.7, p = 0.02), renal failure (OR = 7.98, p = 0.01), reoperation for bleeding (OR = 4.33, p = 0.05), and the need for inotropes in the intensive care unit (OR = 1.79, p = 0.02).
Immediate postoperative hypoalbuminemia was associated with poorer outcomes in OPCAB patients. Monitoring of albumin levels after OPCAB could identify patients at risk for short-term adverse events.
Journal of cardiothoracic and vascular anesthesia 11/2010; 25(3):462-8. · 1.06 Impact Factor
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ABSTRACT: Femoral vein cannulation is an alternative method for central cannulation. However, no clinical guidelines have been established for optimal insertion length of femoral venous cannula. The purpose of the present study was to evaluate the correlation between the insertion length of femoral venous cannula (L), and the sum of the length from femoral artery (FA) puncture site to umbilicus (P-U) and the length from umbilicus to lower border of the sternum (U-S) as an anthropometric estimation for adult patients undergoing cardiovascular surgery using femoral vein cannulation. We also attempted to determine the insertion length of femoral venous cannula by the patient's height and weight.
P-U and U-S were measured after anesthesia induction. L was measured after femoral venous cannula tip was positioned at the junction of inferior vena cava and right atrium using transesophageal echocardiography. The relationship between the sum of P-U and U-S (P-U-S), and L was analyzed by Pearson's correlation analysis. Bland-Altman analysis was used to compare the agreement between P-U-S and L. Multiple linear regression analysis was performed to identify the height and weight factors capable of predicting L.
One-hundred study patients were enrolled. P-U-S was highly correlated with L (r = 0.95). The bias and precision were -2.60 ± 8.57 mm. L was predicted from height and weight: L (mm) = 0.82 × height (cm) + 1.18 × weight (kg) + 188.46.
P-U-S can be used as a reliable anthropometric estimation of L during adult cardiovascular surgery using femoral vein cannulation.
Journal of Cardiac Surgery 11/2010; 26(1):16-21. · 0.87 Impact Factor
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ABSTRACT: We experienced an extremely rare complication during performance of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair for a 57-year-old healthy man. About 50 minutes after CO(2) insufflation, the patient developed tachycardia, hypoxemia, hypercapnia and an increased airway pressure. Right pneumothorax with subcutaneous emphysema was recognized on the emergency chest X-ray and this was successfully treated by chest tube insertion. Anesthesiologists should be aware of the possible occurrence of pneumothorax during laparoscopic TEP hernia repair.
Korean journal of anesthesiology 05/2010; 58(5):490-4.
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ABSTRACT: Intraoperative formation of a thrombus in the right atrium and its management has occasionally been reported. However, spontaneous resolution of right atrial thrombi, without any event, is rare. We report a case of abrupt right atrial thrombus formation and spontaneous resolution, with no events, detected by transesophageal echocardiography during the replacement of an abdominal aortic aneurysm.
Journal of Anesthesia 03/2010; 24(3):456-9. · 0.83 Impact Factor
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ABSTRACT: Anesthetic management for aortic arch aneurysm (AAA) surgery employing deep hypothermic circulatory arrest in a Jehovah's Witness (JW) patient is a challenge to anesthesiologist due to its complexity of procedures and their refusal of allogeneic transfusion. Even in the strict application of intraoperative acute normovolemic hemodilution (ANH) and intraopertive cell salvage (ICS) technique, prompt timing of re-administration of salvaged blood is essential for successful operation without allogeneic transfusion or ischemic complication of major organs. Cerebral oximetery (rSO(2)) monitoring using near infrared spectroscopy is a useful modality for detecting cerebral ischemia during the AAA surgery requiring direct interruption of cerebral flow. The present case showed that rSO(2) can be used as a trigger facilitating to find a better timing for the re-administration of salvaged blood acquired during the AAA surgery for JW patient.
Korean journal of anesthesiology 02/2010; 58(2):191-6.
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ABSTRACT: Endoscopic vein harvest (EVH) for coronary artery bypass grafting surgery is performed with carbon dioxide (CO2) insufflation for visualization and dissection. The insufflated CO2 is rapidly absorbed into the body and may influence haemodynamics. However, the haemodynamic changes during EVH have not been clearly defined. This study evaluated the haemodynamic effects during EVH of the saphenous vein for off-pump coronary artery bypass grafting surgery (OPCAB).
After fixing the position for harvesting of the left internal mammary artery, EVH of the saphenous vein was performed at a maximum CO2 pressure of 12 mmHg and a flow of 3 l/min. The haemodynamic parameters were measured before and just after the end of endoscopic vein harvest.
One hundred patients were studied. The end-tidal CO2 pressure (P(ET)CO2, 35.0 +/- 2.7 vs. 52.0 +/- 6.2 mmHg), partial pressure of arterial CO2 (PaCO2, 35.1 +/- 3.1 vs. 52.5 +/- 4.3 mmHg), mixed venous oxygen saturation (SvO2, 75.6 +/- 4.1 vs. 82.0 +/- 1.6%), cardiac index (2.7 +/- 0.6 vs. 3.3 +/- 0.6 l/min/m2), and cerebral oxygen saturation (ScO2, left: 63.5 +/- 7.9 vs. 73.3 +/- 8.4; right: 62.2 +/- 8.0 vs. 72.3 +/- 6.3%) differed significantly between before and after CO2 insufflation, whereas mean systemic blood pressure, mean pulmonary artery blood pressure, central venous pressure, heart rate, partial pressure of arterial oxygen, and peak inspiratory pressure did not differ significantly between before and after CO2 insufflation.
EVH, at a maximum CO2 pressure of 12 mmHg and a flow of 3 l/min, of the saphenous vein for OPCAB was associated with hypercarbia and a tolerable range of hypercarbia (PaCO2 < 60 mmHg) increased the cardiac index and ScO2 without any complications.
European Journal of Anaesthesiology 11/2009; 26(11):969-73. · 2.23 Impact Factor
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Anesthesia and analgesia 10/2009; 109(4):1038-40. · 3.08 Impact Factor
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ABSTRACT: Warming and humidification of inspired gases is standard care for intubated patients whose lungs are ventilated mechanically for prolonged periods. We examined whether active humidification of inspired gases might reduce laryngo-pharyngeal discomfort in patients undergoing brief laryngeal mask airway (LMA) anesthesia.
In a prospective trial, 200 adult patients undergoing elective surgery under general anesthesia were randomly assigned to receive ventilation without airway warming and exogenous humidification (Group C-control), or active warming and humidification of inspired gases (Group HUM-humidified), using a humidifier with a heated wire circuit. Inhalational anesthesia was maintained via a circle system. The temperatures and relative humidities of inspired gases were monitored continuously throughout surgery. Postoperative sore throat, dysphonia, and dysphagia were assessed one and 24 hr after anesthesia. Whenever symptoms were present, their severities were graded using a 101-point numerical rating scale.
The mean temperature and relative humidity of the inspired gases in Group HUM were greater compared to Group C (36.1+/-0.4 degrees C and 99.5+/-0.5% vs 26.9+/-0.8 degrees C and 76.4+/-10.9%, respectively). Postoperatively, the overall frequencies of laryngeal and pharyngeal discomfort were similar in the two groups (53.8% and 54.9% in Group C vs 51.6% and 41.9% in Group HUM at one and 24 hr respectively, P>0.05). The groups were also similar with respect to the severity scores of laryngo-pharyngeal discomfort.
Active warming and humidification of inspired gases has no clinically appreciable effect in reducing the incidence and severity of laryngo-pharyngeal complaints after brief (<two hours) LMA anesthesia.
Canadian Journal of Anaesthesia 02/2007; 54(2):134-40. · 2.35 Impact Factor
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ABSTRACT: Unilateral thoracic sympathectomy in patients with palmar hyperhidrosis causes a skin temperature drop in the contralateral hand. A cross-inhibitory effect by the post-ganglionic neurons innervating hands is postulated as a mechanism of contralateral vasoconstriction. The purpose of our study was to evaluate whether this cross-inhibitory effect also occurs in the feet. Twenty patients scheduled for thoracoscopic sympathicotomy due to palmar hyperhidosis were studied. Right T3 sympathicotomy was performed first, followed by left T3 sympathicotomy. The thenar skin temperatures of both hands and feet were continuously monitored using a thermometer and recorded before induction of anesthesia, during the operation, 4 hr after and 1 week later. Following right T3 sympathicotomy, the skin temperature of the ipsilateral hand gradually increased, however the skin temperature of the contralateral hand gradually decreased. Immediately after bilateral sympathicotomy, the skin temperature differences between hands and feet increased, but these differences decreased 1 week later. Our results show that cross-inhibitory control may exist in feet as well as in the contralateral hand. Thus, the release of cross-inhibitory control following T3 sympathicotomy results in vasoconstriction and decrease of skin temperature on the contralateral hand and feet. One week later, however, the temperature balance on hands and feet recovers.
Journal of Korean Medical Science 11/2006; 21(5):917-21. · 0.99 Impact Factor
