K W Cheng

Chang Gung Memorial Hospital, T’ai-pei, Taipei, Taiwan

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Publications (11)10.77 Total impact

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    ABSTRACT: Background The study's purpose was to evaluate the effects of total removal of the asictes through laparotomy on the lung function of adult patients undergoing living donor liver transplantation. Basis Procedure One hundred eleven patients were reviewed retrospectively. Patients were grouped into 3 groups: GI had ascites <1000 mL, GII between 1000 and 4000 mL, and GIII >4000 mL. The respiratory compliance (RC), end-tidal carbon dioxide (EtCO2), peak and plateau airway pressures, tidal volume, and ventilator modes used were compared from 5 minutes before to 20 minutes after laparotomy, by using linear regression and repeated measurements. The changes in the RC among groups were tested using one-way analysis of variance (ANOVA), whereas the changes in percentage of the RC in the same group were tested using paired Student t test. Main Findings The changes in RC before and 10 minutes after laparotomy and total removal of the ascites were 45 ± 12 to 47 ± 13, 39 ± 9 to 43 ± 6, and 24 ± 8 to 43 ± 12 mL/cm H2O for GI, GII, and GIII, respectively. Linear regression analysis showed that the R2 of the RC 20 minutes after removal of the ascites was 0.645. Pressure cycled ventilation (PCV) used in GIII significantly increased the tidal volume and low end tidal CO2 after laparotomy. Conclusions Removal of the ascites in patients undergoing living donor liver transplantation (LDLT) tended to improve the RC in all groups, but significant change was only noted in patients with massive ascites (GIII). Resetting of the ventilator is required to prevent hyperventilation when the PCV mode is used in GIII.
    Transplantation Proceedings 01/2014; 46(3):730–732. · 0.95 Impact Factor
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    ABSTRACT: Objective This study aimed to determine whether coronary vein size can serve as a predictor of hemodynamic instability during inferior vena cava clamping in living-donor liver transplantations. Methods Fifty-two patients' hemodynamic data before and after clamping were retrospectively analyzed and compared with the use of linear regression and repeated measurement. Data included arterial blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, stroke volume, stroke volume variation, and systemic vascular resistance. Results The values of hemodynamic parameters at 1, 3, 10, and 30 minutes after clamping were compared with baseline data. All changes were found to be significant when the presence of the coronary vein was not considered. When the coronary vein was taken into consideration, linear regression analysis showed that only the percentage changes of cardiac index; stroke volume at 1, 3, and 10 minutes; and systemic vascular resistance at 1 minute after portal and inferior vena cava clamping were significantly correlated with the presence of the coronary vein. Conclusions Coronary vein size is a weak predictor of hemodynamic tolerability and instability during portal vein and inferior vena cava clamping in this kind of surgery.
    Transplantation Proceedings 01/2014; 46(3):692–695. · 0.95 Impact Factor
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    ABSTRACT: Dantrolene is the drug of choice in treatment of malignant hyperthermia. However, dantrolene is hepatotoxic; thus prolonged use is not recommended in patients with active hepatic disease such as acute hepatitis or active cirrhosis because it may result in fatal hepatic failure. Use of dantrolene in a patient with end-stage liver disease undergoing liver transplantation (LTx) in whom suspected malignant hyperthermia developed has been reported rarely. Its effect on the liver allograft, which has sustained cold, warm, and reperfusion injuries, is currently unknown. We report a case in which low-dose dantrolene administered intravenously during LTx was effective in treating hyperthermia, hypercapnia, and hyperkalemia. Furthermore, its reported hepatotoxic effect seemed to not affect recovery of the allograft after LTx.
    Transplantation Proceedings 04/2010; 42(3):858-60. · 0.95 Impact Factor
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    ABSTRACT: The purpose of the study was to determine the compensatory function of the remnant liver as a blood reservoir after 70% hepatectomy in rats to counteract hemorrhagic shock and reperfusion. One hour of hemorrhagic shock followed by 1 hour of resuscitation induced in normal rats (group I) was compared with animals that had undergone 70% hepatectomy at postoperative day 3 (group II) and day 7 (group III). We compared the total blood loss, the blood pressure before hemorrhagic shock, hemoglobin, hemotocrit, and mortality. Liver function such as aspartate transferase (AST), alanine transferase, and lactate dehydrogenase (LDH) were also compared among groups by one-way analysis of variance with post hoc correction. A P value less than .05 was regarded as significant. The results showed a lower volume of drawn blood induced hemorrhagic shock in group II compared with group I or group III hosts. The blood loss was 15.6+/-1.0, 5.68+/-2.5, and 13.2+/-1.6 mL for groups I, II, and III, respectively. The mortality due to hemorrhagic shock was significantly higher in group II compared with group I or group III. Liver function tests showed that the AST and LDH were significantly higher after resuscitation in group II. In the early postoperative period (day 3) after 70% hepatectomy, rats were more vulnerable to a high mortality after hemorrhagic shock compared with hosts in the late postoperative period (day 7). Significantly higher AST and LDH in group II indicated that the remnant liver was more injured after hemorrhagic shock in the early postoperative period.
    Transplantation Proceedings 04/2010; 42(3):980-2. · 0.95 Impact Factor
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    ABSTRACT: We sought to compare the effects of operation room temperature (ORT) at typical ambient environment (19-21 degrees C) and ORT at 24 degrees C on the core temperature of patients undergoing living donor hepatectomy. Sixty-two patients undergoing living donor hepatectomy were divided into 2 groups. In group I (n = 31), surgery was performed at typical ambient ORT, and in group II (n = 31) in ORT at 24 degrees C. Anesthesia and measures to prevent heat loss, except ORT, were all the same. Nasopharyngeal temperature (NT) was recorded after anesthesia induction, then hourly until completion of the operation. Changes in NTs were analyzed as well as patient age, weight, anesthetic duration, blood loss, intravenous fluids, total urine output, and pre- and postoperative hemoglobin and hematocrit values. The Mann-Whitney U test was used for comparisons between groups. The patient's characteristics between groups were not statistically different. However, a significantly higher core temperature was noted in group II compared with group I. Increased ORT from 19 to 21 degrees C to 24 degrees C resulted in an increased core temperature of at least 0.5 degrees C during living donor hepatectomy.
    Transplantation Proceedings 11/2008; 40(8):2463-5. · 0.95 Impact Factor
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    ABSTRACT: The purpose of this study was to assess factors influencing the end-tidal concentrations of isoflurane within a bispectral index (BIS) range of 45–55 among healthy live liver donors (n = 11), chronic hepatitis B patients undergoing hepatectomy hepatocellular carcinoma (n = 10), and end-stage liver disease patients undergoing liver transplantation (n = 7). Patients data collected prospectively were compared among the groups using one-way analysis of variance as well as univariate and multivariate techniques. The results showed that end-stage liver disease patients required the least end-tidal isoflurane concentration. Patients with hepatocellular carcinoma with cirrhosis required intermediate end-tidal isoflurane concentrations; healthy live liver donors required the highest end-tidal isoflurane concentrations to provide sufficient anesthetic depth, as monitored by a target BIS (range, 45–55). Upon multivariate analysis, liver function was the only significant factor influencing the likelihood of lowering the end-tidal isoflurane concentration by 4 hours after anesthesia induction (P = .026). In conclusion, we recommend a preset target BIS within the range of 45–55 to monitor the depth of anesthesia during partial hepatectomy and liver transplantation because end-tidal isoflurane concentration requirements are different for patients with various liver status. This strategy may protect the patients from intraoperative recall or anesthesia over-depth as a consequence of insufficient or overdose of anesthesia, respectively.
    Transplantation Proceedings 11/2008; · 0.95 Impact Factor
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    ABSTRACT: Previous work by the authors has shown that chest compressions alone without mechanical ventilation during cardiopulmonary resuscitation in the natural supine position was associated with pulmonary aspiration in dogs. The purpose of this investigation was to test the hypothesis that a head down position may prevent aspiration during chest compressions alone and whether oxygenation can be improved by simply insufflation of oral oxygen 10 min after cardiac arrest. Cardiac arrest was induced in ten mongrel dogs which were anesthetized and paralysed. Eight underwent chest compressions alone in different head down positions using an automatic compressor at 9 kg compression force and 3 cm compression depth. The study was composed of two parts. Part 1 evaluated the effect of insufflation of 10 l/min O2, into the mouth of the dogs, 10 min after initiation of resuscitation, using chest compressions alone. Part 2 was designed to test our hypothesis that the head down position may protect the lungs from aspiration during chest compression alone. The mouths of the dogs were filled with mixed barium and the dogs underwent serial episodes of chest compressions, for 10 min each, in the 20 degree head down, 10 degree head down and the natural supine positions. Chest X-rays with antero-posterior and lateral views were taken to evaluate pulmonary aspiration. Two additional dogs underwent direct chest compression alone in the natural supine position and the time of chest compression was shortened to 5 min. All dogs in the natural position showed evidence of pulmonary aspiration of barium, five or six of the dogs showed tracheal aspiration in the 10 degree head down position, while no any barium was visualized in the tracheo-broncheal trees of the dogs in the 20 degree head down position. Supplemental oxygen in the mouth improved the mean PaO2 from 67 +/- 26 to 160 +/- 97 mmHg during chest compressions alone. Chest compression alone without mechanical ventilation in the supine position caused pulmonary aspiration in the unprotected airway in dogs. This complication could be prevented by adopting a 20 degree head down position. The 10 degree head down position seemed to reduce the severity of the pulmonary aspiration, but not enough to eliminate the danger altogether. Supplemental oxygen in the mouth can improve oxygenation in chest compressions alone.
    Resuscitation 08/2000; 45(2):133-8. · 4.10 Impact Factor
  • C H Wang, K W Cheng, B Jawan, J H Lee
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    ABSTRACT: Most anesthesiologists at one time or other saw the anesthetic management of patients with aortic aneurysm who underwent surgical procedures other than correction of aneurysm with or without prior knowledge of the existence of the aneurysm. The risk of intraoperate rupture of aneurysm depends on its size, type, severity, and presentation of symptoms; stress and unstable hemodynamics have been usually held responsible for the aggravation and even rupture of aneurysm. There are numerous other factors that affect the hemodynamic force during anesthesia and surgery, the increase of which would be very dangerous to the surgical patients with aortic aneurysm whether they receive anesthesia for a radical correction of the disease per se or for a surgical procedure unrelated to its correction. Therefore the anesthetic management of a patient with aortic aneurysm is a great challenge which the anesthesiologist must accept. Here, we present eleven cases of aortic aneurysm, who underwent non-corrective surgery during 1992-1998. There were eight cases of thoracoaortic dissecting aneurysm and three cases of abdominoaortic aneurysm. All underwent laparotomy under general anesthesia without the aneurysm being corrected. We reviewed the anesthetic management of these patients retrospectively. Our review showed that no aneurysm rupture was noted in these eleven cases. Seven of the eleven patients are still alive at the time of this report. We are of the opinion that under close monitoring and with prompt treatment, the allowance of a slow climb of arterial pulse pressure is acceptable and would not increase the risk of aneurysm rupture.
    Acta anaesthesiologica Sinica 04/2000; 38(1):3-7.
  • Transplantation Proceedings 07/1996; 28(3):1721-2. · 0.95 Impact Factor
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    ABSTRACT: Many parturients and their obstetricians believe that spinal anesthesia will cause low back pain (LBP). We studied prospectively a total of 160 parturients; 80 of them had cesarean section (CS) with spinal anesthesia and another 80 who had natural childbirth. Incidence of LBP was investigated and compared in these patients before pregnancy, during pregnancy and postpartum. Our result showed that before pregnancy, about one third (33.1%) of the parturients already had LBP and the incidence of LBP seemed to increase during pregnancy. The incidence of LBP decreased gradually postpartum. There was no difference in the incidence of postpartum LBP between the CS with spinal anesthesia group and the natural childbirth group. We concluded that postpartum LBP could be related to changes during pregnancy and not related to spinal anesthesia.
    Acta anaesthesiologica Sinica 12/1994; 32(4):243-6.
  • K W Cheng, C H Wang, R T Ho, B Jawan, J H Lee
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    ABSTRACT: We studied retrospectively the outcome of surgery and anesthesia in 294 patients aged 80 and older who underwent 362 surgical procedures. Of these, 52 cases (14.4%) were admitted to intensive care unit (ICU) post-operatively. The 48-hour, 48-hour-to-30-day and overall mortality rates were 0.8%, 3.8% and 5.2% respectively. ICU. admission and mortality rate were closely associated with the ASA physical status classification. The overall mortality rates were 1.3%, 5.7% and 27% in class II, III and IV respectively. The respective ICU admission rates were 3%, 20% and 56%. ICU admission rate and mortality rate were 42.5% and 13.8% in emergency surgery vs. 5.8% and 2.5% in elective surgery. Patients with 3 or more co-existing diseases had the mortality rate of 23% and the rates of ICU admission and mortality for those with 3 or more peri-operative complications were 22% and 16% respectively vs. 11% and 4% for those with 2 or less peri-operative complications. General surgery was associated with the highest mortality rate (15%) than other type of procedures. 22 of 74 cases who underwent intra-abdominal surgery required controlled ventilation for more than 24 hours post-operatively. 59% (13 cases) of such cases could not weaned successfully from ventilators and died subsequently. Only 2.5% (7 cases) of cases who underwent extra-pleural and extra-peritoneal procedures required controlled ventilation for more than 24 hours post-operatively. Of these, 2 died subsequently. For comparison, the study were artificially divided into two phases, each of three years long: they were the period from 1986-1988 and the period from 1989-1992.(ABSTRACT TRUNCATED AT 250 WORDS)
    Acta anaesthesiologica Sinica 04/1994; 32(1):37-43.