-
An Experience of Right Pneumonectomy in a Lung Cancer Patient with Poor Pulmonary Function Test within the Conventional Criteria of Contraindication to Surgery: Intraoperative Re-evaluation of Pulmonary Function: A case report
-
Jin Young Chon, Sung Jin Hong, Ung Jin, Hae Jin Lee, Yong Woo Choi, Se Ho Moon, Sun Hee Lee, Man Seok Bae
-
Korean J Crit Care Med. 1999;14(2):167-175.
-
-
-
 Abstract
 PDF
- Usually FEV1 lower than 1 liter is considered as a contraindication to pneumonectomy. Therefore sometimes, the curative operations of the resectable lung cancer can not be performed in case of poor pulmonary functions. The usual criteria on the performance of pneumonectomy on high risk patients based on the preoperative assessment of pulmonary function may not predict the operative outcome with accuracy in the postoperative period. Nowadays, there are some arguing points about applying the values of preoperative PFTs to pulmonary resection surgery. We performed a right pneumonectomy for stage IIIb lung cancer in a patient with poor lung function test; FVC 2.17 L, FEV1 0.97 L, FEV1/FVC 44%, FEF 25~75% 0.42 L/sec, MVV 28 L/min, TLC 5.18 L, RV 2.99, DLCO 13.46. After the temporary ligation of right main pulmonary artery during 30 minutes, arterial blood gas and percutaneous oxygen saturation with the controlled ventilation with room air (FiO2=0.21) confirmed the hemodynamic and oxygenation stabilities, twice. After successful surgery, the patient was tolerated for 4 months.
And the follow up PFTs at postoperative 3 months and 18 days showed as follows; FVC 1.20 L, FEV1 0.63 L, FEV1/FVC 53%, FEF 25~75% 0.31 L/sec, MVV 25 L/min, TLC 3.80 L, RV 2.33 L, DLCO 8.04. Through the intraoperative re-evaluation of pulmonary function in a patient with poor preoperative PFTs,had been conventionally considered as a contraindication to pneumonectomy, we report a successful surgery and anesthetic management with the literatures reviewed.
-
The Effect of Clonidine Pretreatment on Bupivacaine-induced Cardiac Toxicity in Rabbit
-
Eun Ju Lee, Jin Young Chon, Yong Woo Choi, Se Ho Moon
-
Korean J Crit Care Med. 1998;13(2):205-211.
-
-
-
Abstract
PDF
- BACKGOUND: Bupivacaine, an amide type local anesthetic, is frequently used for regional anesthesia. Bupivacaine overdose induces cardiac toxicity and directly depresses both cardiac electrophysiology and hemodynamic status.
Clonidine, an imidazolin alpha-2-adrenoreceptor agonist, given prophylactically may delay the toxic manifestation of bupivacaine overdose and does not accentuate the subsequent hypotension. We studied the effect of clonidine pretreatment on bupivacaine induced cardiac toxicity.
METHODS
Fourteen rabbits (seven in each group) were anesthetized with ketamine and rompun, and tracheostomy was performed. Spontaneous ventilation with room air was continued throughout the experiment. Electrocardiogram, heart rate, and invasive arterial blood pressure were continuously recorded. Clonidine 5 microgram/kg (clonidine group) or saline (control group) was injected intravenously in randomized fashion. After 15 minutes, an intravenous infusion of bupivacaine was started at 0.3 mg/kg/min. The time of occurrence of the bupivacaine-induced toxic events: first dysrhythmia, 25% and 50% reduction in basal heart rate and mean arterial pressure, and asystole were recorded. At 5, 10, 15, and 20 minutes after bupivacaine infusion, 2 ml of whole blood were withdrawn via femoral arterial catheter for determination of bupivacaine concentration.
RESULTS
The threshold time at the first dysrhythmia was significantly greater in the clonidine group (27.2+/-4.5 min) than control group (19.9+/-1.2 min). The threshold times at the 25 and 50% reduction in basal heart rate were significantly greater in the clonidine group (23.7+/-5.8 min, 33.2+/-5.1 min) than control group (16.6+/-2.9 min, 22.9+/-2.8 min) and in basal mean arterial pressure were significantly greater in the clonidine group (15.6+/-2.6 min, 25.3+/-3.7 min) than control group (9.7+/-2.7 min, 16.3+/-5.8 min). The threshold time at the asystole was significantly greater in the clonidine group (38.2+/-7.7 min) than control group (28.7+/-3.4 min). At 5, 10, 15, and 20 minutes after bupivacaine infusion, there was no significant difference in the plasma bupivacaine concentration between two groups.
CONCLUSION
This study demonstrates that clonidine pretreatment delays the cardiac toxic manifestations of bupivacaine overdose. And plasma bupivacaine concentration was not influenced by clonidine pretreatment.
-
Cerebral Hemorrhage Following Anesthesia for a Patient with Takayasu's Arteritis: A case report
-
Keon Hee Ryu, Yoon Ki Lee, Yong Woo Choi, Jai Min Lee, Chang Sung Kim, Soo Kyung Song
-
Korean J Crit Care Med. 1998;13(1):113-113.
-
-
-
Abstract
PDF
- Takayasu's arteritis is a nonspecific inflammatory arteritis involving the aorta and its major branches. Stroke may be an important and predictive complication for the prognosis in such patient. A 48-year-old woman got a bypass operation 3 months ago because of both subclavian artery and left common carotid artery occlusion, but she still suffered from headache, dizziness and tingling sensation and had no pulse of right arm. So, she got a bracheoaxillary bypass reoperation. Anesthesia was performed with enflurane-N2O-O2.
At the recovery room, her mental state was deep drowsy and she revealed high blood pressure and abnormal neurological sign. Her brain computed tomography revealed cerebral hemorrhage at left frontotemporal basal ganglion area.
Emergent hematoma removal of brain was done. Post- operatively this patient sustained an intracerebral hemorrhage in the initial hemorrhagic site despite immediate reoperation. She was discharged home without improvement at postoperative 5 days. This report is a description of Takayasu's arteritis with massive cerebral hemorrhage following a reoperation of occluded bypass surgery.
|
KSCCM
