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Rationale: Idiopathic ventricular tachycardia (VT) occurs in individuals without structural abnormalities in the heart, accounts for approximately 10% of total VTs. Furthermore, approximately 70% of idiopathic VTs originate from Right ventricular outflow tract (RVOT). However, among perioperative arrhythmias, incidence of VT after surgery is extremely rare and most arrhythmias are atrial origin. Patient concerns: A 69-year-old man with permanent pacemaker underwent colon surgery. Diagnoses: Patient suffered from low blood pressure and dizziness, sweating at post anesthetic care unit (PACU) and heart rate (HR) increased suddenly to 200 beats/min with monomorphic VT after bolus ephedrine administration and continuous dopamine infusion. Interventions: Pacemaker interrogation followed by DC cardioversion was done. Outcomes: Patient's vital signs became normal and symptoms are subsided. Lessons: RVOT VT can be caused by triggering activities, such as ephedrine, dopamine, and inadequate fluid management. These triggering activities are initiated by acceleration of HR from ventricles with infusion of catecholamine which lead monomorphic VT originating from RVOT. RVOT origin PVCs can be precipitated into monomorphic VT by administrating catecholamines such as ephedrine and dopamine even in patient with pacemaker. The mechanism of these VTs includes catecholamine induced acceleration of HR. Since RVOT PVCs can be recognize by 12 EKGs, we should be pay more attentions to the pre-operation EKG and be cautious using catecholamines.

Purpose: Previously, we reported the presence of virus-encoded microRNAs (miRNAs) in the urine of prostate cancer (CaP) patients. In this study, we investigated the expression of two herpes virus-encoded miRNAs in prostate tissue. Methods: A total of 175 tissue samples from noncancerous benign prostatic hyperplasia (BPH), 248 tissue samples from patients with CaP and BPH, and 50 samples from noncancerous surrounding tissues from these same patients were analyzed for the expression of two herpes virus-encoded miRNAs by real-time polymerase chain reaction (PCR) and immunocytochemistry using nanoparticles as molecular beacons. Results: Real-time reverse transcription-PCR results revealed significantly higher expression of hsv1-miR-H18 and hsv2-miRH9- 5p in surrounding noncancerous and CaP tissues than that in BPH tissue (each comparison, P

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.

Purpose: The frequency of thoracic endovascular aortic repair (TEVAR) is increasing due to lower morbidity and mortality than that of open repair. The aim is to evaluate the results of TEVAR in patients with thoracic aortic disease. Methods: Twenty seven patients have undergone TEVAR from October, 2003 to November, 2012. Aortic diagnoses were 7 descending thoracic aortic aneurysms, 6 acute descending aortic dissections, 6 traumatic aortic transactions, 4 aortic arch aneurysms, 2 chronic descending aortic dissections, and 2 penetrating aortic ulcers (PAU). Multi detector computerized tomography (MDCT) aortography was done at one week, one month, six months, and one year interval. Results: Indications for TEVAR were aortic diameter of more than 5.5 cm in 9 patients, traumatic aortic transaction in 6, persistent chest pain in 4, increasing aortic diameter during follow-up period in 3, aneurysm rupture in 3, and PAU more than 2 cm in 2. Hybrid TEVAR was done in 7 patients. Primary technical success, showing complete aneurysmal exclusion, was done except in one patient (96%). There was one operation death (4%). Two patients developed perioperative stroke, but recovered without sequelae. MDCT was done during the mean of 18 months (range, 1 to 98 months) follow-up period. Small type I endoleak was found in two patients (7%), and type III endoleak was found in a patient (4%). Stent graft migration was in one patient. There was no aorta related deaths during the follow-up period. Conclusion: Intermediate term result of TEVAR in patients with thoracic aortic aneurysmal disease was encouraging. It may be used as a treatment option for thoracic aortic disease.

Although paraganglioma (PGL), an extra-adrenal retroperitoneal pheochromocytoma (PHEO), is a rare catecholamine-secreting neuroendocrine tumor, it can cause severe hypertensive crisis during anesthesia or surgery if undiagnosed preoperatively. Extraluminal perigastric masses may be presumed to be gastrointestinal stromal tumors (GISTs) or soft tissue sarcomas even when histologic confirmation is not possible. Therefore, without a histologic diagnosis or symptoms of excessive catecholamine secretion, PGL may be mistaken for GIST. We report a case of preoperatively undiagnosed PGL which caused hypertensive crisis during anesthesia for retroperitoneal mass excision.

We performed a pharmacogenetic study to analyse the correlation between the clinical responses to ondansetron during a 24-h postoperative period and two single nucleotide polymorphisms (−100_–102 delAAG and ins/delCA) in the serotonin receptor type 3B gene (HTR3B) in 280 Korean patients with tonsillectomy (TS, n=108) or surgery because of gynaecological problems (GY, n=172). The effect of CA/CA homogyzous variant of the ins/delCA allele on lowering the prevention of postoperative vomiting was significant, particularly during the initial 2 h postoperative period (P=0.034) and in the GY group (P=0.013 for complete response and P=0.009 for prevention of vomiting). However, we failed to detect a significant effect of genotypes for the −100_–102delAAG allele during our observation period. Our results suggest that ins/delCA polymorphism in the HTR3B may have clinical relevance to the expected clinical response to prevent postoperative vomiting in patients treated with ondansetron.

www.ekja.org Background: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery. Methods: One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient’s satisfaction with the anesthetic technique was assessed after surgery. Results: There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner’s syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient’s satisfaction. Conclusions: Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications. (Korean J Anesthesiol 2010; 58: 260-266)

Objective This study was designed to evaluate the serial haemodynamic changes during coronary artery anastomoses using two deep pericardial stay sutures and octopus tissue stabilizer in patients undergoing initial experiences of off-pump coronary artery bypass graft surgery (OPCAB) using continuous cardiac output and mixed venous oxygen saturation (SvO(2)) monitoring. Methods With IRB approval, thirty patients undergoing OPCAB were studied. Pulmonary artery catheter (PAC) for continuous cardiac output and SvO(2) monitoring was inserted before anaesthesia. Haemodynamic measurements were recorded after pericardiotomy for baseline value. During each coronary artery anastomosis, haemodynamic variables were measured at 1,3,5,10, and 15 min after the application of tissue stabilizer and after the removal. Vasopressors were used to maintain mean arterial pressure (MAP) higher than 60 mmHg. Results MAP and heart rate (HR) were maintained without significant change during the anastomoses of all three arteries. Cardiac index (CI), and SvO(2) decreased significantly after stabilizer application in all three arteries. CI was below 2.5 l/min/m(2) and SvO(2) was under 70% during left circumflex artery (LCX) anastomosis. The decrease in CI and SvO(2) were significantly greater during LCX anastomosis. The increase in mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) was significant only in left anterior descending artery (LAD). Central venous pressure (CVP) increased significantly during the anastomosis of all three coronary arteries. The differences in MPAP, PCWP and CVP among the three coronary arteries were not statistically significant. The highest dose of vasoconstrictor was used during LCX anastomosis. Conclusions When the coronary anastomoses were performed with two deep pericardial stay sutures and octopus tissue stabilizer on the beating heart, CI and SvO(2) decreased significantly during all coronary artery anastomoses immediately after the stabilizer application and the degree of reduction in CI and SvO(2) increased with time, though MAP was maintained constantly. CI and SvO(2) during LCX anastomosis were consistently below normal values. Therefore close monitoring and proper managements are needed during graft anastomoses.

Interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery. One of the disadvantages of this technique is the risk of hemidiaphragmatic paresis, which can occur as a result of phrenic nerve block and can cause a decrease in the pulmonary function, limiting the use of the block in patients with reduced functional residual capacity or a preexisting pulmonary disease. However, it is generally transient and is resolved over the duration of the local anesthetic's action.We present a case of a patient who experienced prolonged hemidiaphragmatic paresis following a continuous interscalene brachial plexus block for the postoperative pain management of shoulder surgery, and suggest a mechanism that may have led to this adverse effect.Nerve injuries associated with peripheral nerve blocks may be caused by several mechanisms. Our findings suggest that perioperative nerve injuries can occur as a result of combined mechanical and chemical injuries.

Objective: Redistribution hypothermia adversely affects hemodynamics and postoperative recovery in patients undergoing cardiac surgery. In off-pump coronary bypass surgery (OPCAB), maintaining the temperature is important because warming by cardiopulmonary bypass is omitted. Prewarming studies reported earlier showing prewarming as an effective means of preventing redistribution hypothermia was time consuming since it required at least 1—2 h to prewarm the patients before the surgery. Because prewarming for such a long time is impractical in clinical practice, this study evaluated the efficacy of active warming during the preanesthetic period for the prevention of redistribution hypothermia in the early operative period of OPCAB. Methods: After gaining the approval of Institutional Review Board and informed consent from the patients, 40 patients undergoing OPCAB were divided into control and prewarming groups. The patients in control group (n = 20) were managed with warm mattresses and cotton blankets, whereas patients in prewarming group (n = 20) were actively warmed with a forced-air warming device before the induction of anesthesia. Hemodynamic variables and temperature were recorded before anesthesia (Tpre) and at 30 min intervals after anesthesia for 90 min (T30, T60, and T90). Results: Active warming duration was 49.7 � 9.9 min. There were no statistically significant differences in skin temperature, core temperature and hemodynamic variables between the two groups at preinduction period except for mean arterial pressure and central venous pressure. The core temperature at T30, T60, and T90 was statistically higher in prewarming group than that in control group. Core temperature of six (30%) and seven patients (35%) in control group was reduced below 35 8C at T60 and T90, respectively, whereas core temperature of only one patient (5%) in prewarming group was reduced below 35 8C at T90 (P = 0.02). Conclusions: Active warming using forced air blanket before the induction of anesthesia reduced the incidence and degree of redistribution hypothermia in patients undergoing OPCAB. It is a simple method with reasonable cost, which does not delay the induction of anesthesia nor the surgery. # 2005 Elsevier B.V. All rights reserved.

Background. Jugular bulb oxygen saturation (Sjvo2) is a surrogate marker for global cerebral oxygenation. The effect of milrinone on Sjvo2 and the cerebrovascular carbon dioxide reactivity (CCO2R) was investigated. Methods. Thirty patients scheduled for coronary artery bypass graft surgery (CABG) were studied prospectively. After sternotomy, normoventilation (at T1; Paco2=4.7–5.0 kPa) and hyperventilation (at T2; Paco2=3.3–3.7 kPa) were induced and the changes in Sjvo2 (Paco2) and P a 2 ( Δ P a 2 ), and Δ S j 2 / Δ P a 2 (CCO2R) were measured. After normoventilation was re-established (at T3), milrinone 50 μg kg−1 was given (at T4), followed by hyperventilation (at T5), and Δ S j 2 , Δ P a 2 and CCO2R were measured. Results. After milrinone administration at normoventilation (T3 and T4), cardiac index and mixed venous oxygen saturation increased, while mean arterial pressure and systemic vascular resistance index decreased, without a significant change in S j 2 . Before milrinone administration (T1 and T2), hyperventilation decreased P a 2 and S j 2 , and Δ S j 2 showed positive linear correlation with Δ P a 2 . After milrinone administration (T4 and T5), hyperventilation decreased P a 2 and S j 2 , and Δ S j 2 showed positive linear correlation with Δ P a 2 . There was no significant difference in CCO2R before and after milrinone administration (13.3 (5.7)% kPa−1 and 12.3 (3.9)% kPa−1, respectively). Conclusions. Although milrinone induced significant haemodynamic changes, S j 2 and CCO2R were unchanged during its administration.

Summary The haemodynamic effects of a continuous infusion of milrinone without an initial bolus dose were evaluated in patients undergoing off-pump coronary artery bypass graft surgery. After internal mammary artery harvest, milrinone 0.5 μg.min−1.kg−1 (29 patients) or a normal saline infusion (33 patients) was started and continued until all graft anastomoses were completed. Haemodynamic variables were recorded before application of the tissue stabiliser, at 1, 3, 5 and 10 min after the application of the stabiliser, and after its removal. The administration of a milrinone infusion was associated with a smaller decrease in cardiac output and mixed venous oxygen saturation during all the coronary artery anastomoses, with no severe complications and a decreased dose of norepinephrine infused to maintain systemic arterial pressure.

Methods and results We report here with a case corresponding to the above disease entity, in which pulmonary veins were drained into a separate posterior chamber, which was connected to the common atrium, thus forming cor triatriatum. A 42-yearold Asian female was consulted for operation of p-ECD and PLSVC, which were detected during the evaluation of complete heart block. She complained of worsening dyspnea and syncope attack for recent one year. The PLSVC had no connection with right sided SVC and was thought to be drained into the left atrial roof directly. The operation was carried out under standard hypothermic cardiopulmonary bypass. A large common atrium without septal remnant was encountered on opening right atrium. The coronary sinus opening was absent and PLSVC was directly drained into atrial roof, to the right of the left atrial appendage. An opening measuring 3x3cm, which at first was confused as atrial septal defect, was seen to the right of PLSVC. An accessory chamber, draining all four pulmonary veins was connected to the common atrium by this opening. After closing mitral valve cleft, a generous intraatrial patch made of bovine pericardium was used to partition the common atrium. The opening connecting pulmonary venous chamber to the atrium was widely extended inferiorly and the upper part of the opening was partly closed to minimize distortion of the patch. The left atrial appendage was also incorporated into the right side of patch to simplify the baffling procedure. The tricuspid annuoplasty was carried out and permanent epicardial pacemaker was implanted n the end. The patient recovered without events.

Background We compared the incidence and degree of post-operative nausea and vomiting (PONV) in patients who received general anesthesia with propofol or sevoflurane using the Rhodes index of nausea, vomiting, and retching (RINVR) to assess the degree of PONV quantitatively and objectively during the post-anesthetic period. Methods We performed a prospective study involving 38 patients who underwent gynecologic laparoscopic surgery in our hospital between September 2008 and August 2009. Nineteen patients were anesthetized with propofol during the entire anesthetic period and the other 19 patients received 2.0 mg/kg of propofol intravenously, followed by sevoflurane inhalation. Three patients who were anesthetized with sevoflurane were excluded from the analysis because they were omitted during the survey. We studied the patients who had PONV and RINVR scores 1, 6, and 24 hours post-operatively. Results The propofol group had a statistically lower incidence of PONV and lower RINVR scores in the following subclasses within 1 hour of surgery: symptom occurrence; symptom distress; and symptom experience. Conclusions Propofol at induction and during maintenance of anesthesia can be used to prevent PONV within 1 hour post-operatively in patients undergoing gynecologic laparoscopic surgery.

Right internal jugular vein catheterization is performed frequently as central venous catheterization by the landmark method. This procedure, however, might prove difficulty due to anatomic variations or thrombosis of internal jugular vein. We failed to catheterize right internal jugular vein by the landmark method in 70-year-old female patient. And then, we detected right internal jugular vein thrombosis by ultrasound scan. Left internal jugular vein catheterization was performed by the ultrasound guided technique. Central venous catheterization has possibility to fail despite several attempts by the landmark method. Then, ultrasound guided approach is a good choice to aid central venous catheterization when difficulties or complications have been encountered.

Continuous epidural analgesia is commonly used for chronic pain treatment as well as postoperative pain control. Epidural abscess is rare, but it is a serious complication of the continuous epidural analgesia, which leads to neurologic sequelae. Epidural catheter was inserted to a 87-year-old woman who complained of postherpetic neuralgia from T6 dermatome for continuous epidural analgesia. Two weeks later, neuralgia was aggravated along with back pain and tenderness around catheter insertion area. ESR and CRP level was also elevated. Epidural abscess was detected on MRI scan right after removal of catheter. It has been improved with percutaneous drainage via Tuohy needle with antibiotics without need for surgery. We conclude that percutaneous drainage with antibiotics is an effective method for the treatment of early diagnosed epidural abscess without neurologic deficit, especially in the high risk patients for operation. (Korean J Anesthesiol 2008; 54: 123∼6)

Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immedi ate proper intensive care. The operation was delayed and a skin test was performed on the 7 th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction. (Korean J Anesthesiol 2008; 55: 613～7)

Iatrogenic vertebro-vertebral arteriovenous fistula (AVF) is an uncommon complication resulting from various procedures such as central venous catheter insertion. The incidence may be underestimated since the diagnosis is not easy because of its rarity. A central venous catheterization via the internal jugular vein was attempted in a 43-year-old female who presented for intracranial aneurysmal clipping under general anesthesia. Inadvertent arterial puncture was recognized as pulsatile arterial blood flow through the needle. The needle was removed and local compression was applied to the puncture site. The catheter was inserted via the right femoral vein. After surgery, the patient recovered from anesthesia without any complications. On postoperative day 5, thrill and bruit on the right side of the neck were noted on physical examination. Angiography confirmed vertebro-vertebral AVF, which was successfully obliterated with a stent 3 months later.

Menkes disease, socalled kinky hair disease or steely hair disease, is a rare Xlinked recessive disorder of intracellular copper transport protein ATP7A defect, due to mutation of ATP7A gene, resulting in copper deficiency. It is characterized by seizure, retarded neurological development, kinky hair, skeletal abnormality, recurrent infection and subnormal body temperature. In addition, gastroesophageal reflux with the risk of aspiration is another important feature. This article is the first report of anesthetic management in a patient with Menkes disease who underwent gastrostomy and bladder diverticulectomy in Korea.

Vasopressin, an extremely potent vasoconstrictor, has been widely used for surgical hemostasis in gynecological practices. But, Intramyometrial infiltration of vasopressin is not free of side effects and may cause lethal complications including pulmonary edema, myocardial infarction, and cardiac arrest in spite of infrequency of reported cases. Sudden cardiac arrest was encountered just after intramyometrial injection of vasopressin in our patient undergoing dilation and curettage. We believe that this awful complication was due to baroreflex-mediated regulation of blood pressure, caused by unintentional penetration of vasopressin into the vessels. We herewith discuss the complications of the local injection of vasopressin and the safe dose of vasopressin for intramyometrial injection. (Korean J Anesthesiol 2007; 53: 664～7)

Background: It is generally known that neuraxial anesthesia for adults reduces the demand for hypnotics needed for adequate sedation. Therefore, this study examined the effect of a preoperative caudal block on the general anesthetic requirements for an adequate depth of anesthesia in children. Methods: Twenty children aged 3-5 years, who were set to undergo inguinal herniorraphy, were divided into 2 groups of 10 children each, normal saline and lidocaine groups. Tracheal intubation was performed. After setting up the bispectral index (BIS) monitor, a caudal block was administered to both groups differently, normal saline 0.7 ml/kg was administered to the normal saline group and 1.5% lidocaine 0.7 ml/kg was administered to lidocaine group. The end-tidal concentration of sevoflurane was maintained at 1.5 vol% for 10 minutes in the first patient in both groups, and the BIS value, was measured 6 times every 10 seconds, and averaged. When the BIS was ≥ 50, the end-tidal concentration of sevoflurane was increased by 0.2 vol% in the subsequent patient. When the BIS was less than or equal to 50, the end-tidal concentration of sevoflurane was decreased by 0.2 vol% in the subsequent patient. The MACBIS50 in both groups was calculated using probit analysis. Relative median potency analysis was used to compare the results in both groups. Results: The MACBIS50 of sevoflurane was significantly lower with a 1.5% lidocaine caudal block (1.40 vol% [95% CI, 1.25-1.55 vol%]) compared with the normal saline group (1.77 vol% [95% CI, 1.61-2.00 vol%]). Conclusions: A preoperative caudal block reduces the demand for sevoflurane required for an adequate depth of anesthesia, as measured by the BIS in children. (Korean J Anesthesiol 2007; 52: 29～33)

Postoperative hepatotoxicity may develop from many causes. One of them is direct injury to the liver cell due to anesthetic agents. Each agent has different hepatotoxic risk. Sevoflurane is known to have a very low potential for hepatotoxicity. We report a case of severe hepatic dysfunction after anesthesia with sevoflurane in a pediatric patient who underwent cardiopulmonary bypass surgery.

In patients undergoing cardiac surgery, unintentional systemic hypothermia causes peripheral vasoconstriction and thus increases myocardial afterload, and coagulopathy and postoperative bleeding can also occur. In the field of cardiac surgery, the performance of off-pump coronary artery bypass graft surgery (OPCAB) has become more frequent, and active temperature control management has become one of the important parts of anesthetic management for OPCAB. However, elevating room temperature, warming intravenous fluids, and heating ventilator gases have limited effect. There have been numerous reports that active warming before anesthesia reduces the core-to-peripheral tissue temperature gradient and the propensity for heat redistribution after the induction of anesthesia and as a result prevents intraoperative hypothermia. Previous studies have shown that at least 1-2 hours of prewarming prevented intraoperative hypothermia but was considered as impractical. Recently, it has been reported that a brief period of prewarming, for example 15 minutes, would be easy to accommodate and could be combined with intraoperative warming, which is undoubtedly effective after the redistribution period. This study was designed to evaluate the efficacy of active preoperative warming with forced air on the development of intraoperative hypothermia in patients undergoing cardiac surgery. Active Warming during Preanesthetic Period Reduces Hypothermia without Delay of Anesthesia in Cardiac Surgery

Background: Aspirin has been shown to effectively increase survival and reduce morbidity in patients with ischemic heart disease. Continued aspirin use during the preoperative period could increase the postoperative blood loss in patients who have on-pump coronary artery bypass grafting. This study aimed to determine the effect of continued aspirin use before off-pump CABG on intraoperative and postoperative bleeding and coagulation profile in thromboelastography. Methods: In 43 patients undergoing OPCAB, they were assigned aspirin user (n = 22), who received aspirin until the day of operation or nonaspirin user (n = 21), who discontinued aspirin before 7 days before the surgery. Intraoperative and postoperative bleeding and transfusion requirement were measured. TEG was performed and R, K, angle, maximum amplitude and TEG index was measured at preinduction and at 24 hours after surgery. Results: There were no differences in patient characteristics between aspirin users and nonaspirin users. We found no significant difference between postoperative bleeding and blood product requirements for the two groups. Similarly, we found no significant difference in the coagulation profiles. Conclusions: The use of aspirin continued preoperatively does not increase intraoperative and postoperative blood loss, and blood product requirement and influence on coagulation profile.

Background: During general anesthesia, the most commonly used way of keeping airway patency is endotracheal intubation. However, for relatively short and simple surgery, less invasive method using laryngeal tube (LT) or laryngeal mask airway (LMA) is generally accepted and the comparative study between the two apparatus is now being actively done. In this study, we evaluated the usefulness of two apparatus from pediatric patients. Methods: We select 58 children from one to ten years old who are to be given short operation and then anesthetize 30 children by using LT and 28 children by LMA. The size of LT and LMA is chosen by body weight according to the manufacturer´s recommendation. We evaluated the seal pressure of LT and LMA, ventilatory efficiency, attempt number, facility of insertion, proper positioning confirmed by fiberoptic bronchoscopy, and complications. Results: There was no statistically significant difference in the attempt number and facility of insertion between the two groups. LT and LMA were both properly positioned and the ventilation efficiency was not different from the two groups. The LT group shows higher seal pressure than the LMA group and there is no correlation between sealing pressure and ventilation efficiency. There is close correlation between bronchoscopic grade and ventilatory efficiency. complications are not different between two groups. Conclusions: Both LT and LMA are useful for simple surgery of children and LT has higher sealing pressure.

Background: Preoperative -adrenergic receptor (-AR) antagonist administration is known to improve ventricular function by decreasing the myocardial oxygen demand in coronary artery obstructive disease (CAOD). This study evaluated the effect of preoperative propranolol on response to -AR agonist, dobutamine in patients undergoing off-pump coronary artery bypass graft surgery (CABG) Methods: Twenty six patients undergoing off-pump CABG, and treated with propranolol preoperatively, were enrolled in this study. After anesthesia, the infusion of dobutamine was started at 2/kg/min (D2) for 5 min and then increased to 4/kg/min (D4) and 8/kg/min (D8) in succession. The same protocol was performed twice before and after coronary artery anastomosis (pre-graft and post-graft). Hemodynamic variables were measured just before the infusion of dobutamine (D0, baseline) and after each dobutamine infusion at D2, D4 and D8. Results: No significant change was observed in the cardiac index (CI) during the pre-graft period, but CI increased significantly at D4 and D8 compared with D0 during the post-graft period. Mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP) and systemic vascular resistance index (SVRI) increased at D2, D4 and D8 and heart rate (HR) decreased at D2 and D4 during the pre-graft period. MAP and SVRI did not change and HR and CI increased at D4 and D8 during the post-graft period. The % change of CI from D0 significantly increased at D4 and D8 during the post-graft period than during the pre-graft period but not at D2. MAP, SVRI and MPAP after dobutamine infusion significantly increased during the pre-graft period than during the post-graft period. HR showed a reversed trend. Conclusions: Dobutamine infusion did not exert any known positive inotropic effect, besides increased MAP, MPAP and SVRI, in patients treated with propranolol preoperatively undergoing off-pump CABG during the pre-graft period. Meanwhile, dobutamine exerted slight inotropic effects during the post-graft period. Cautious use of dobutamine during the pre-graft period is needed in patients treated with propranolol preoperatively.

Background: Coronary artery bypass grafting without cardiopulmonary bypass (Off-Pump Coronary Artery Bypass Grafting, OPCAB) causes significant hemodynamic derangement by displacement of the beating heart. The purpose of this study was to analyze the hemodynamic changes caused in relation to grafted arteries by displacing the heart and stabilizing the coronary arteries in patients undergoing OPCAB. Methods: Nineteen patients underwent OPCAB using two deep pericardial sutures and tissue stabilizers (Octopus Tissue Stabilization Syetem, Medtronic, USA). The hemodynamic variables were obtained after induction of anesthesia, after deep pericardial sutures, before and after anastomosis of each coronary artery during epicardial stabilizing, after sternal closure, and after postoperative 6 hours and 12 hours in the intensive care unit. Results: The hemodynamic variables were maintained with the Trendelenburg position, volume loading and low dose vasopressors after deep pericardial stay sutures. Displacement of the heart and placement of the stabilizer on all coronary territories except the obtuse marginal artery before anastomosis showed no significant difference in hemodynamics compared with baseline. Positioning for the graft to the obtuse marginal artery decreased cardiac index (1.6 0.4 L/min/) and stroke index (27.6 9.9 L/beat/) and increased systemic vascular resistance (2318.9 673.7 dyne . sec . ), resulting in hemodynamic compromise (P

Background : Bradycardia frequently occur in intravenous anesthesia with propofol. Patients with sinus bradycardia have increased vagal tone at rest. The purpose of this study is to evaluate the effect of propofol on blood pressure and heart rate during induction of anesthesia in patients with sinus brads-cardia. Methods : Sixteen adult patients were studied. No anticholinergics were used before induction. Anesthesia was induced intravenously with midazolam 0.03 mg/kg, propofol 2 mgfkg, lidocaine 1 mg/kg and vecuronium 0.12 mg/kg. Anesthesia was maintained with continuous iufusion of propofol 150 ug/kg/min and 100% O2. Hemodynamic data were recorded 3 minutes after nidazolam injection, imme- diately aftar propofol injection, 1 and 2 minutes after propofol continuous infusion, and immediately, 1, 3 and 5 minutes after intubation. Results : Heart rate significantly increased after intravenous injection of propofol (P < 0.05) and was maintained during the study. There was no incidence of bradycardia. Conclusions : Anesthesia induction and maintenance with propofol could be a suitable and safe ansethetic method for patients with sinus bradycardia. (Korean J Anesthesiol 2000: 38: 14∼19)