Effects of Transfusion on the Values of Serum Electrolytes and Platelets in Pre- and Post Operation

Hemolytic transfusion reaction, transmission of infectious diseases such as hepatitis or syphilis, allergic reaction, volume overload and metabolic changes due to banked blood transfusion have been known as the results of the transfusion. There are many reports for the complications of massive transfusion such as hyperkalemia, hypocalcemia, bleeding diatheses by the deficits of coagulation factors. We study the values of the serum potassium, calcium, sodium and platelets after small amounts (1-2 units) of transfusion in the pre-and postoperation. In the dept. of anesthesiology in E.W.U.H. forty patients scheduled for surgery were allocated into the adults and children group with twenty patients in each group. The each group was divided in the nontransfused control and transfused group. The results were as follow : 1. In the control and transfused group of the adults, the mean age were 40.6±14.7 year-old, 47.4±17.1 year-old, the mean values of body weight 58.2±9.8 kg, 59.1±5.8 kg, the mean values of hemoglobin 13.47±2.22 g%, 12.29±2.11 g%, hematocrit 39.59±6.06%, 37.32±6.65%, the ratio of estimated blood loss to total blood volume 4.61±1.84%, 18.65±8.79% and the ratio of the amounts of transfusion to the total blood volume 14.87±8.07% in the transfused group of the adults. In the control and transfused group of the children the mean age were 4.67±2.94 year-old, 4.61±1.61 year-old, the mean body weight 17.21±6.40 kg, 14.60±7.93 kg, the mean value of hemoglobin 12.36±0.93 g%, 11.90±l.57 g%, hematocrit 37.16±3.63%, 36.14±4.68%, the ratio of estimated blood loss to the total blood volume 4.87±3.71%, 29.06±23.19% and the ratio of the amount of transfusion to the total blood volume 23.51±15.6% in the transfused group of the children. 2. In the control group of the adults and children, there were not significant changes of the values of the serum potassium, calcium, sodium and platelets in the pre-and postoperation. 3. Only the transfused group of the children the values of platelets show significant decrease statistically, but not any significant changes of values of the serum potassium, calcium, sodium and platelets in the adults and the children group. In conclusion the values of the serum electrolytes were not any significant changes after non-massive transfusion. In the transfused group of the children the value of platelets show significant decrease statistically (p<0.05) but, the hemorrhagic tendency was not found clinically.;수혈로 인하여 여러가지 부작용 즉, 용혈성 반응, 간염이나 매독 등의 전염성 질환의 전파, 과민 반응, 체액 과다증과 저장 혈액 수혈에 따른 대사성 변화 등이 발생할 수 있으며, 특히 대량수혈 후에는 고칼륨혈증, 저칼슘혈증, 혈액 응고 인자 결정에 의한 출혈성 장애가 일어날 수 있다. 그러나 수술하는 모든 경우에, 수혈을 반드시 해야 할 정도로 실혈하는 것은 아니며, 수혈을 하는 경우 일반적으로 대량수혈보다는 소량수혈 (1∼2 units)을 많이 하고 있어서 이러한 소량수혈 후 오는 합병증을 고려해야 한다. 그러므로, 이런 소량수혈 후 오는 혈액 변화 및 합병증에 대한 보고는 거의 없어 본 저자는 소량수혈 후의 혈청 전해질치 및 혈소판치를 관찰하기 위하며 수술받은 환자 40명을 대상으로 성인 20명, 소아 20명을 선택분류한 후 각군을 10명씩 수술중 수혈하지 않은 대조군과 수혈한 시험군으로 분류, 4군으로 나누어 수술 직전과 수술 종료 1시간 후에 정맥혈을 채취하여 혈청 potassium, calcium, sodium 치 및 혈소판치를 측정하여 각 군간의 변화를 비교 관찰하여 다음과 같은 결과를 얻었다. 1. 성인에서 대조군과 시험군의 평균 연령은 40.6±14.7세, 47.4±17.1세, 체중은 58.2±9.8 kg, 59.1±5.8kg, 혈색소치는 13.47±2.22 g% 12.29±2.11 g%, 헤마토코리트치는 39.59±6.06%, 37.32±6.65%, 전혈량에 대한 실혈향의 비율은 4.61±1.84%, 18.65±8.97%이었으며, 시험군에서 실혈량에 대한 수혈량의 비율은 14.87±8.07%였다. 소아에서 대조군과 시험군의 평균 연령은 4.67±2.94세, 4.32±4.00세, 체중은 17.21±6.40 kg, 14.60±7.93 kg, 혈색소치는 12.36±0.93 g%, 11.90±1.57 g%, 헤마토크리트치는 37.16±3.63%, 36.14±4.68%, 전혈량에 대한 실혈량의 비율은 4.83±3.71%, 29.06±23.19 %였으며, 시험군에서 전혈량에 대한 수혈량의 비율은 23.51±15.60%였다. 2. 성인 및 소아 대조군에서의 수술 전 후의 혈청 potassium ,calcium, sodium 치 및 혈소판치의 변화는 통계학적으로 의의가 없었다. 3. 소아 시험군에서 수혈 후 혈소판치가 통계학적으로 의의있는 감소(p<0.05)를 보였다.목차 = ⅲ 논문개요 = ⅴ Ⅰ. 서론 = 1 Ⅱ. 관찰대상 및 방법 = 3 Ⅲ. 성적 = 5 A. 각 군의 성별, 연령, 체중, 혈색소치, 헤마토크리트치, 실혈량 및 수혈량 = 5 B. 성인군에서의 수술 전후의 혈청 전해질치 및 혈소판치 = 10 C. 소아군에서의 수술 전후의 혈청 전해질치 및 혈소판치 = 10 Ⅳ. 고안 = 15 Ⅴ. 결론 = 21 참고문헌 = 23 ABSTRACT = 2

The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. A recent study indicated that changes in PPV or SVV obtained by transiently increasing VT (VT challenge) accurately predicted fluid responsiveness even in critically ill patients receiving low VT. We evaluated whether the changes in PPV and SVV induced by a VT challenge predicted fluid responsiveness during pneumoperitoneum. Methods: We performed an interventional prospective study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 min after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 min after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 min). Fluid responsiveness was defined as ≥15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, an increase in PPV > 1% after the VT challenge showed excellent predictive capability for fluid responsiveness, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI), 0.83-0.99, P < 0.0001; sensitivity 92%, specificity 86%]. An increase in SVV > 2% after the VT challenge predicted fluid responsiveness, but showed only fair predictive capability, with an AUC of 0.76 (95% CI, 0.60-0.89, P < 0.0006; sensitivity 46%, specificity 100%). The augmented values of PPV and SVV following VT challenge also showed the improved predictability of fluid responsiveness compared to PPV and SVV values (as measured by VT) of 6 ml/kg. Conclusions: The change in PPV following the VT challenge has excellent reliability in predicting fluid responsiveness in our surgical population. The change in SVV and augmented values of PPV and SVV following this test are also reliable. Trial registration: This trial was registered with Clinicaltrials.gov, NCT03467711, 10th March 2018. © 2019 The Author(s)

Arytenoid cartilage dislocation mimicking bilateral vocal cord paralysis: A case report

Rationale:Arytenoid dislocation is very rare and may be misdiagnosed as vocal cord paralysis or a self-limiting sore throat.Patient Concerns:A 70-year-old male (70kg, 156cm) was scheduled for transurethral resection of bladder tumors. A McGrath videolaryngoscope, with a basic cuffed Mallinckrodt oral tracheal tube of 7.5mm internal diameter, was used to successfully intubate his trachea. The duration of surgery was 25minutes. In the recovery room, he complained of sore throat and dyspnea with inspiratory stridor, which were not resolved after intravenous injection of 10mg of dexamethasone.Diagnoses:The otolaryngological examination revealed midline fixation of the bilateral vocal folds, suggestive of bilateral arytenoid dislocation or bilateral vocal cord palsy. The latter was ruled out because there was no evidence of recurrent laryngeal nerve injury.Interventions:Under general anesthesia, a closed reduction was performed using laryngoscopic forceps to apply posterolateral pressure on the arytenoid joints on both sides. Only the dislocation of the left cricoarytenoid joint could be easily reduced, whereas reduction of the right joint was not possible.Outcomes:On postoperative day 7, examination with a rigid laryngoscope showed a medially fixed right vocal fold, with full compensation by the left vocal fold. Computed tomography of the neck showed no pathologic findings. Six weeks after surgery, the patient had regained his normal voice with no complications.Lessons:Although arytenoid dislocation is a rare complication, it should be considered even in patients with uncomplicated tracheal intubation. Early diagnosis and the optimal therapeutic approach are critical for restoration of the patient's original vocal cord function

Effect of Stellate Ganglion Block on the Cerebral Cortex: A Functional Magnetic Resonance Imaging Study

The objective of this study is to investigate the neural activities in the human brain after stellate ganglion block (SGB) treatment using functional magnetic resonance imaging (fMRI). Thirteen healthy female volunteers from the local community participated in the study. An echo planar imaging sequence for fMRI has used to examine the effect on the cerebral cortex before and after SGB stimulation at 1.5T MRI. We used 6 mL of 1 % mepivacaine hydrochloride as a local anesthetic. Two control groups with and without a saline injection were also included. FMRI data were processed using statistical parametric mapping. The blood-oxygen-level-dependent fMRI signal intensities increased in contralateral anterior cingulate cortex, hypothalamus, ventral putamen, and parahippocampal gyrus after SGB stimulation, while the signal intensities had decreased in contralateral thalamus and dorsal putamen, and ipsilateral caudate nucleus. In the saline control group, the signal intensities in ipsilateral posterior putamen and superior temporal gyrus and both insular cortices have increased significantly. The present study could show the changes by SGB in the several important brain areas associated with sympathetic nervous system. The non-invasive and repeatable imaging technique of fMRI could provide some useful information for better understanding of the neural mechanisms involved in SGB treatments

Factors Affecting Maternal and Fetal Outcomes of Non-Obstetric Surgery and Anesthesia during Pregnancy: a Retrospective Review of Data at a Single Tertiary University Hospital

Background: Anesthesia during pregnancy for non-obstetric surgery is generally known to have a negative impact on maternal and fetal outcomes. We assessed the risk of adverse outcomes in fetuses and mothers associated with non-obstetric surgery. Methods: This retrospective study analyzed clinical data on pregnant women who received non-obstetric surgeries at a tertiary university hospital. We reviewed maternity admissions using hospital administrative data during the last 16 years. The outcome assessment included the presence of preterm labor, premature birth, abortion, or stillbirth and the data of newborns. Statistical analyses were performed using the t-test, chi(2) test, and multiple logistic regression was used for risk analysis. Results: The incidence of non-obstetric surgery during pregnancy was 0.96%. Gestational age at or above 20 weeks increased the risk of all adverse events 4.5 fold when it was compared to gestational age less than 20 weeks, although the events were only preterm labor or premature birth and no fetal loss. All fetal loss cases occurred in patients at less than 20 weeks of pregnancy. The risk of adverse outcome increased by 2% for every 1 minute increase in anesthesia time. Babies of the mothers who had the adverse outcome event showed lower birth weight and higher neonatal intensive care unit admission rate than those of babies of the mothers without any adverse event after the surgery. Conclusion: Physicians should acknowledge and prepare for common possible adverse events at the stage of pregnancy after non-obstetric surgery, and effort to shorten the duration of surgery and anesthesia is needed

Impending compartment syndrome of the forearm and hand after a pressurized infusion in a patient under general anesthesia - A case report

A 74-year-old woman underwent posterior lumbar decompressive fusion at L4-5 for treating spondylolisthesis, with the patient under general anesthesia and she was in the prone position. Following attempts to transfuse blood using a pressurized bag, the intravenous infusion site of the left hand along with the noninvasive blood pressure cuff was changed. Swelling and several bullae on the left forearm and hand were visible. Removal of intravenous catheter, hyaluronidase injection, wet dressing were subsequently performed. In postanesthesia recovery unit, the patient did not complain of pain, and the radial pulse and oxygen saturation of the left appeared normal. Three days after the incident, the edema on the patient's forearm and hand subsided, and the patient was discharged without any complications two weeks afterwards. Impending compartment syndrome should be given close attention, and particularly when performing pressurized infusion in patients who are unable to express pain because they are under general anesthesia. Copyright © the Korean Society of Anesthesiologists, 2011

The changes of heart rate variability after unilateral stellate ganglion block

Background: The effect of the unilateral stellate ganglion block (SGB) on cardiovascular regulation remains controversial. We wished to evaluate the changes in heart rate variability (HRV) after a unilateral stellate ganglion block in patients with head and neck pain in the present study. Methods: Patients with head and neck pain (n = 89) were studied. HRV was determined before and after a C6 unilateral stellate ganglion block (right-sided SGB, 40; left-sided SGB, 49) using a paratracheal technique with 1% mepivacaine (6 ml). Results: There were no significant differences in HRV indices before and after right-sided SGB. The log scale of power in the high frequency range (InHF) was increased and ratio of power in the lowfrequency range (PF) to power in the high frequency range (HF) ratio was decreased after left-sided SGB. Conclusions: These results demonstrated that left-sided SGB increased parasympathetic activities in patients with head and neck pain. Copyright © Korean Society of Anesthesiologists, 2010

Effect of stellate ganglion block on the cerebrovascular system : Magnetic resonance angiography study

Background: Several studies have shown that stellate ganglion block (SGB) is an effective treatment for certain cerebrovascular related diseases; however, the direct effect of SGB on the cerebral vasculature is still unknown. The present study investigated the effect of SGB on the cerebral vascular system using magnetic resonance angiography. Methods: Time-of-flight magnetic resonance angiography images of 19 healthy female volunteers (mean ages of 46.4± 8.9 yr) were obtained before and afterSGBwith 1.5-T magnetic resonance imaging. The authors determined successful interruption of sympathetic innervation to the head with the appearance of Horner syndrome and conjunctival injection. We measured changes in the average signal intensity and diameter of the major intracranial and extracranial arteries and their branches, which were presented with mean (±SE). Results: The signal intensity changes were observed mainly in the ipsilateral extracranial vessels; the external carotid artery (11.2%, P < 0.001) and its downstream branches, such as the occipital artery (9.5%, P < 0.001) and superficial temporal artery (14.1%, P < 0.001). In contrast, the intensities of the intracranial arteries did not change with the exception of the ipsilateral ophthalmic artery, which increased significantly (10.0%, P = 0.008). After SGB, only the diameter of the ipsilateral external carotid artery was significantly increased (26.5%, P < 0.001). Conclusions: We were able to observe significant changes in the extracranial vessels, whereas the intracranial vessels were relatively unaffected (except for the ophthalmic artery), demonstrating that both perivascular nerve control and sympathetic nerve control mechanisms may contribute to the control of intracranial and extracranial blood vessels, respectively, after SGB. Copyright © 2010

The effects of hip abduction with external rotation and reverse Trendelenburg position on the size of the femoral vein; ultrasonographic investigation

Background: Femoral vein (FV) catheterization is required for critically ill patients, patients with difficult peripheral intravenous access, and patients undergoing major surgery. The purpose of this study was to evaluate the effects of hip abduction with external rotation (frog-leg position), and the frog-leg position during the reverse Trendelenburg position on diameter, cross-sectional area (CSA), exposed width and ratio of the FV using ultrasound investigation. Methods: Ultrasonographic FV images of 50 adult subjects were obtained: 1) in the neutral position (N position); 2) in the frog-leg position (F position); 3) in the F position during the reverse Trendelenburg position (FRT position). Diameter, CSA, and exposed width of the FV were measured. Exposed ratio of the FV was calculated. Results: The F and FRT positions increased diameter, CSA and exposed width of the FV significantly compared with the N position. However, the F and FRT positions had no significant effect on exposed ratio of the FV compared with the N position. The FRT position was more effective than the F position in increasing FV size. Conclusions: The F and FRT positions can be used to increase FV size during catheterization. These positions may increase success rate and reduce complication rate and, therefore, can be useful for patients with difficult central venous access or at high-risk of catheter-related complication. © the Korean Society of Anesthesiologists, 2011

Cerebral fat embolism after bilateral total knee replacement arthroplasty

Fat embolism syndrome is a rare and potentially lethal complication most commonly seen in long bone fractures and intramedullary manipulation. The clinical triad of fat embolism syndrome consists of mental confusion, respiratory distress, and petechiae. This study reports a case of cerebral fat embolism syndrome following elective bilateral total knee replacement. After an uneventful anesthesia and initial recovery, the patient developed neurologic symptoms nine hours postoperatively. Copyright © 2010 Korean Society of Anesthesiologists