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Postoperative Acute Cerebral Infarction Occurring after General Anesthesia
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Seong Ho Ok, Seong Min Yang, Woochan Kim, Il Woo Shin, Heon Keun Lee, Young Kyun Chung, Ju Tae Sohn
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Korean J Crit Care Med. 2013;28(4):323-326.
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DOI: https://doi.org/10.4266/kjccm.2013.28.4.323
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 Abstract
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- The common predisposing risk factors for perioperative stroke include: previous stroke, atrial fibrillation, old age (> 75 years), carotid stenosis, and diabetes mellitus.
An endoscopic sinus surgery was performed in a 49-year-old male with chronic paranasal sinusitis and nasal polyps. The vital signs, physical and laboratory examinations, and electrocardiography on admission were within the normal limit. Anesthesia was maintained with nitrous oxide in oxygen and 6% desflurane. The operation and anesthesia were uneventful with the exception of transient intraoperative hypotension. The patient recovered fully from the anesthesia (modified Aldrete score: 10) in the recovery room. However, he developed right arm weakness and dysarthria in the general ward 7 hours after the operation. We report a rare case of multifocal acute cerebral infarctions found on the postoperative magnetic resonance imaging in a noncardiac surgical patient.
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The Carina as a Landmark for Evaluation of Adequate Central Catheter Tip Position with Computerized Tomography
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Il Woo Shin, Mi Young Park, Ju Young Choi, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung
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Korean J Crit Care Med. 2006;21(1):37-41.
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Abstract
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- BACKGROUND
The aim of this study was to determine whether the carina can be used as a landmark for evaluation of adequate central catheter tip position, and to examine the relationship between easily measurable body size and variable anatomical parameter.
METHODS
The SVC dimensions and relationship to radiographic landmarks were retrospectively determined from computerized tomography (CT) scans of 200 patients. The CT findings were assessed in terms of SVC length (SVCL), the distance between the carina and the right atrium inlet (CAL), and the sternal length (STL). Pearson's correlation and a regression test for height versus SVCL, STL versus SVCL and CAL were performed.
RESULTS
The median length of the SVC was 4.2 cm (range; 1.6 to 7.2 cm) and the distance between the carina and the right atrium inlet was 2.4 cm (range; 0.8 to 5.6 cm). With the regression test, height was correlated with SVCL (r(2)=0.09), and STL was correlated with both SVCL (r(2)=0.12) and STL (r(2)=0.04).
CONCLUSIONS
The carina was located always above the right atrium inlet. The carina was a reliable, simple anatomical landmark for the determination of correct placement with computerized tomography.
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Comparison of Ventilations with LMA and Endotracheal Tube during Closed Circuit Anesthesia
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Il Woo Shin, Kyeong Eon Park, Hee Dong Chung, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung
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Korean J Crit Care Med. 2004;19(2):126-129.
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Abstract
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- BACKGROUND
LMA has larger dead-space than tracheal tube, ventilation may be influenced by difference of dead space.
Closed circuit mechanical ventilation has high risk of hypercarbia because of inadequate CO2 elimination or gas supply. Thus, end-tidal carbon dioxide tension (EtCO2) and arterial carbon dioxide tension (PaCO2) were compared during closed circuit mechanical ventilation with LMA or tracheal tube. METHODS: Thirty adult patients scheduled for general anesthesia were divided into 2 groups. After induction of general anesthesia, laryngeal mask airway (Group 1, n=15) or tracheal tube (Group 2, n=15) were randomly inserted and closed circuit mechanical ventilation was initiated. When steady state had been reached, PaCO2 and EtCO2 were recorded. RESULTS: The PaCO2 was 32.2+/-2.8 (Group 1), 31.5+/-2.2 (Group 2) and the EtCO2 was 33.0+/-2.9, 31.6+/-2.4 respectively and there was no statistical significance between groups. The difference of arterial and end-tidal carbon dioxide tension in each group was -0.8+/-2.6, -0.03+/-2.2 respectively and there was no statistical significance between groups. CONCLUSIONS: The results indicate that in patients who are mechanically ventilated via the closed circuit system, EtCO2, PaCO2, and the difference between arterial and end-tidal carbon dioxide tension were not significantly different between groups.
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Right Internal Jugular Venous Thrombosis Occurred after Long-term Placement of Hemodialysis Catheter Inserted Via Right Subclavian Vein: A Case Report
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Mi Young Park, Il Woo Shin, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung
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Korean J Crit Care Med. 2003;18(2):80-83.
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- Central venous catheter-related venous thrombosis is one of the most important complications occurred after central venous catheterization. Forty six year old man had end-stage renal failure due to diabetes mellitus. Temporary hemodialysis catheter was inserted via right subclavian vein. Thirty days after hemodialysis catheter insertion, the patient presented with right neck swelling and difficulty to aspirate blood from hemodialysis catheter. Venography showed right internal jugular vein thrombosis. We report a case in which a patient developed right internal jugular vein thrombosis after long-term placement of temporary hemodialysis catheter.
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Atelectasis Due to Epistaxis Aspiration during Awake Fiberoptic Nasotracheal Intubation
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Ju Tae Sohn, Sang Jung Lee, Kyung Il Hwang, Heon Keun Lee, Sang Hwy Lee, Young Kyun Chung
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Korean J Crit Care Med. 1998;13(1):91-96.
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- Indication for fiberoptic intubation in an awake patient include almost any abnormality that may hinder the expeditious placement of an endotracheal tube during anesthetic induction. An epistaxis is the most frequent complication of nasotracheal intubation. The patient was admitted for open reduction and internal fixation due to severe mandible fracture. We experienced a case of atelectasis due to epistaxis aspiration during awake fiberoptic nasotracheal intubation in the conscious patient regionally anesthetized by both superior laryngeal nerve block and translaryngeal anesthesia, which is treated by saline irrigation, suction, active coughing and chest percussion.
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Effect of Positive End-Expiratory Pressure on Intraocular Pressure in the Critically Ill and Mechanically Ventilated Patients
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Ju Tae Sohn, Heon Young Ahn, Ji Hong Bae, Heon Keun Lee, Sang Hwy Lee, Young Kyun Chung
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Korean J Crit Care Med. 1997;12(2):151-158.
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Abstract
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- BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation.
METHODS
Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order.
RESULTS
IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed.
CONCLUSIONS
The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.
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