Journal of Yeungnam Medical Science

Heung Dae Kim

13 Articles

Attenuation of pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum in laparoscopic cholecystectomy.: Sun Ok Song, Hae Mi Lee, Sung Soo Yun, Hwarim Yu, Soo Young Shim, Heung Dae Kim; Yeungnam Univ J Med. 2016;33(2):90-97. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.90

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Abstract PDF: BACKGROUND
We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. METHODS: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. RESULTS: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). CONCLUSION: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

Comparisons of Gas Analysis in Arterial, Venous and Warmed Venous Blood During Inhalation General Anesthesia: Heung Dae Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S519-526. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S519

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Abstract PDF: Background
：We determine whether venous blood, when sampled under carefully controlled conditions, was an acceptable alternative to arterial blood for the measurement of arterial blood gas analysis during inhalation general anesthesia. Materials and Methods：The arterial blood values of the carbon dioxide tension (PCO₂), pH, base excess (BE), oxygen tension (PO₂) and oxygen saturation (SO₂) were compared with the values of venous blood drawn from the cephalic vein as non controlled routine method and as localized warmed method during inhalation general anesthesia with sevoflurane and N₂O (50%) in 20 cases.
Results
：The blood gas analysis values of non controlled cephalic venous blood were close to those of arterial blood. They was similar between the PCO₂ (42.5 ± 0.97 vs. 38.7 ± 0.92 mmHg), pH (7.35 ± 0.01 vs. 7.39 ± 0.01) and BE (-3.13 ± 0.62 vs. -0.18 ± 0.13 mEq/l) of non controlled cephalic venous and of arterial blood. Although the PO₂ in non controlled cephalic venous blood was significantly less than that in arterial blood(130.8 ± 8.1 vs. 245.3 ± 6.8 mmHg), the difference in SO₂ was small(98.9 ± 2.1 vs. 99.7 ± 0.4%). The blood gas values of warmed cephalic venous blood were more similar to those of arterial blood (PCO₂, 41.2 ± 0.91 vs. 38.7 ± 0.92 mmHg; pH, 7.37 ± 0.01 vs. 7.39 ± 0.01; BE, -2.30 ± 0.62 vs. -0.18 ± 0.13 mEq/l; PO₂, 157.3 ± 11.4 vs. 245.3 ± 6.8 mmHg; SO₂, 99.2 ± 1.3 vs. 99.7 ± 0.4%) than to those of non controlled cephalic venous blood.
Conclusion
：We found that warmed cephalic venous blood during inhalation general anesthesia can be arterialized and PCO₂, pH, BE and SO₂ of warmed cephalic venous blood were not significantly different to those of arterial blood. Therefore we conclude that it is reliable to use localized warmed cephalic venous blood for the measurement of arterial blood gas analysis during inhalation general anesthesia.

Changes of Hemodynamic Parameters, Plasma Catecholamines and Vasopressin Level During Laparoscopic Cholecystectomy and in Recovery Period: Heung Dae Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S527-537. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S527

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Abstract PDF: Background
：Laparoscopic cholecystectomy produces less tissue trauma than conventional open procedure does. But, during this procedure, the deliberate pneumoperioneum with carbon dioxide(CO₂) gas insufflation may cause some problems, such as hypercarbia, hypertension, tachycardia, and other changes of cardiovascular function. We analyze the physiologic mechanism of these hemodynamic effects under laparoscopic surgery with CO₂ gas insufflation during inhalation general anesthesia. Materials and Methods：We studied randomly selected 5 healthy patients undergoing laparoscopic cholecystectomy with CO₂ gas insufflation. Each patient inhaled sevoflurane and nitrous oxide gas(50%). The blood pressure, heart rate, end-tidal carbon dioxide level were measured during all the anesthetic procedures. We collected venous blood samples to determine the plasma level of epinephrine, norepinephrine and vasopressin, at 10 minutes after insufflation of CO₂ gas into peritoneal cavity, and at 10 minutes after patient arrived in recovery room. We measured the plasma level of epinephrine and norepinephrine using double antibody method, and vasopressin level using radioimmunoassay method.
Results
：Mean arterial pressure and heart rate was significantly increased, after intraperitoneal insufflation of CO₂ gas(19.3%, 44.7% respectively), and in recovery period(15.8%, 28.6% respectively). The plasma concentration of epinephine was 47.1 ± 30.3 pg/ml(reference intervals, less than 100 pg/ml) at 10 minutes after insufflation of CO₂ gas, and 53.1 ± 25.8 pg/ml at 10 minutes in recovery room. The plasma concentration of norepinephine was 125.7 ± 44.8 pg/ml (reference intervals, less than 600 pg/ml) after insufflation, and 179.1 ± 42.1 pg/ml in recovery room. The plasma concentration of vasopressin was 43.3 ± 34.5 pg/ml(reference intervals, less than 6.7 pg/ml) after insufflation, and 25.3 ± 16.7 pg/ml in recovery room.
Conclusion
：The laparoscopic cholecystectomy with CO₂ gas insufflation in general anesthesia with sevoflurane and in recovery room results in increased mean arterial pressure, heart rate, and decreased plasma concentration of epinephine and norepinephine and increased plasma concentration of vasopressin.

Treatment of Atelectasis Dectected in the Recovery Room after General Anesthesia: Chang jae Hwang, Heung dae Kim, Dae pal Park, Il suk Seo, Sun ok Song, Sae yeon Kim, Dae lim Jee, Deok hee Lee; Yeungnam Univ J Med. 2007;24(2 Suppl):S696-701. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S696

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Abstract PDF: Atelectasis is a relatively common complication following surgery in anesthetized patient with respiratory symptoms, but rarely occur in normal healthy patient. Anesthesiologists must be wary to prevent atelectasis, because it may lead to hypoxia during and after the operation. This case reports a healthy patient without previous respiratory symptoms who developed left lower lobar atelectasis after general anesthesia. Vigorous chest physiotherapy including intended coughing, deep breathing, chest percussion and vibration under postural change was effective. Therefore, vigorous chest physiotherapy is essential part of early treatment modalities for atelectasis in postoperative recovery room.

Subcutaneous Emphysema and Inflammation of the Neck after Tracheal Puncture by an Intubating Stylet.: Gul Jung, Woo Mok Byun, Hyung Jun Lim, Jong Gyun Kim, Dong Min Kwak, Deok Hee Lee, Sae Yeon Kim, Sun Ok Song, Il Sook Seo, Dae Lim Jee, Heung Dae Kim, Dae Pal Park; Yeungnam Univ J Med. 2007;24(2):344-344. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.344

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Abstract PDF: Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-old male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack-Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion appeared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.

Risk Factors of Acute Renal Failure after Colorectal Surgery.: Hae Mi Lee, Chang Jae Hwang, Jaehwang Kim, Heung Dae Kim, Dae Pal Park, Il Suk Seo, Sun Ok Song, Sae Yeon Kim, Deuk Hee Lee, Daelim Jee; Yeungnam Univ J Med. 2007;24(2):275-286. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.275

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Abstract PDF: BACKGROUND
Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.

Effects of Inspiratory Pressure Preset on Alveolar Gas Exchange Using Anesthetic Ventilator.: Il Sook Suh, Hee Ju Kang, Heung Dae Kim; Yeungnam Univ J Med. 1988;5(1):105-110. Published online June 30, 1988; DOI: https://doi.org/10.12701/yujm.1988.5.1.105

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Abstract PDF: The study was undertaken to determine the most adequate tidal volume when used volume preset ventilator during anesthesia. The thirty patients were received controlled mechanical ventilation with constant inspiratory pressure of 10 cmH2O and respiratory frequency of 12/minute. The results were as follows: 1) The PH was 7.39±0.01 and it is within normal limit. 2) The PaCO2 was 34.0±0.6 mmHg and it is a slightly hyperventilatory state. 3) The PaO2 was 228.0±8.2 mmHg. 4) The Buffer base was 20.7±0.3 mEq/L and it is a slightly buffer base deficient state. From the above results. We concluded that if patients were fully relaxed during general anesthesia, it is desirable to maintain the inspiratory pressure of anesthetic mechanical ventilator to 10 cmH2O for adequate alveolar ventilation.

Extremity Amputation following Radial Artery Cannulation in Patient with Craniectomy.: Heung Dae Kim, Sun Ok Song, Kyeong Sook Lee; Yeungnam Univ J Med. 1987;4(1):145-149. Published online August 31, 1987; DOI: https://doi.org/10.12701/yujm.1987.4.1.145

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Abstract PDF: The technique of radial artery cannulation and its complications are well documented, but serious complications are rare. This is a report of one case of amputation of wrist due to finger necrosis developed from the radial artery cannulation in patient who had craniectomy surgery. This 52-year-old 79 kg male underwent subdural hematoma removal surgery. Right radial artery cannulation was carried out percutaneously using 22 gauge Teflon extracath needle after modified Allen's test appeared to be positive. It was intermittently flushed by heparinized solution. His arterial blood pressure was maintained 100/70-110/80 mmHg and 5 units of banked whole blood and 1 unit of fresh frozen plasma were transfused during 8-hours operation. Cannula was removed on the 9th hour after operation because that was obstructed. On the 12th hour after removal of cannula, his right hand noted to be cool and cyanotic. So, warm towel and hot bag applied continuously on the right hand and the right stellate ganglion block was carried out every day for 4 times. However, on the 10th day after removal of cannula, necrotic change of all fingers of the right hand became worse and skin of fingers were shrunken. Therefore, disarticulation of the right wrist carried out on the 71th day of his hospitalization.

Changes in Blood Glucose and Electrolyte During Open Heart Surgery.: Byeung Lyeul Yoo, Heung Dae Kim, Tae Sook Lee; Yeungnam Univ J Med. 1987;4(1):65-74. Published online August 31, 1987; DOI: https://doi.org/10.12701/yujm.1987.4.1.65

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Abstract PDF: This study deals with the changes in the concentrations of blood glucose and electrolytes during open heart surgery. Blood glucose and electrolytes in connection with age, disease and anesthetic period were measured in 25 patients about to undergo heart surgery which were performed between June 1986 and August 1986 in Yeungnam University Hospital. Because glucose solution is commonly used as priming solution, and the priming solution is hyperglycemic and hyperosmolar, glucose level of priming solution in this study was adjusted to 100-200 mg% level to minimize hyperglycemic and hyperosmolar effect. The following results were obtained. 1. Glucose level of priming solution before extracorporeal circulation was 151.6+31.3 mg%. 2. With body cooing, blood glucose level was elevated. As duration of extracorporeal circulation is prolonged, blood glucose level was elevated more, but no difference between age and diseases were observed. On warning, blood glucose level was progressively lowered. 3. Despite the low serum potassium level during by-pass, the potassium level was progressively elevated following by pass, cut the serum potassium level was low compared to control values. Elevated calcium level was maintained during by pass.

Anesthetic Management for Patients with Increased Intracranial Pressure.: Heung Dae Kim; Yeungnam Univ J Med. 1986;3(1):13-24. Published online December 31, 1986; DOI: https://doi.org/10.12701/yujm.1986.3.1.13

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Abstract PDF: No abstract available.

The Effect for Intracranial Pressure during Laryngoscopy and Endotracheal Intubation.: Heung Dae Kim, Yong Chul Chi; Yeungnam Univ J Med. 1985;2(1):45-51. Published online December 31, 1985; DOI: https://doi.org/10.12701/yujm.1985.2.1.45

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Abstract PDF: It is well known that intracranial pressure (ICP) and mean arterial pressure (MAP) are increased by laryngoscopy and endotracheal intubation during induction of general anesthesia, and it may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the range of ICP increase during induction of the conventional general anesthesia with intubation following thiopental and succinylchohne injections. Intracranial pressure and MAP were measured in 13 patients who underwent craniotomy. All the patients were monitored cerebral epidural ICP and intraarterial pressure preoperatively. The results were as follow: 1. Intracranial pressure was increased of 7.1±7.23 mmHg. 2. Arterial pressure was increased of 43.5±25.46 mmHg. 3. Cerebral perfusion pressure was increased of 33.3±27.53 mmHg. It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patients with increased ICP.

The Effect of Hypobaric Priming Solutions on Extracorporeal Circulation during Open Heart Surgery.: Sun Ok Song, Jung Kook Suh, Heung Dae Kim; Yeungnam Univ J Med. 1984;1(1):101-106. Published online December 31, 1984; DOI: https://doi.org/10.12701/yujm.1984.1.1.101

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Abstract PDF: Before beginning the extracorporeal circulation, perfusionists should supply oxygen into the oxygenator and establish blood flow through the blood line of the heart-lung machine. But these manipulation can induce severe hypocarbic state of priming solutions due to wash out of CO2 gas in the solution. This study was carried out to examine the relationship of blood gas changes between hypocarbic priming solutions and body circulation in 15 patients undergoing open heart surgery with extracorporeal circulation. PaCO₂, pH, buffer base and PaO2 were measured from priming solutions before and 15 minutes after the extracorporeal circulation. The results were as follows; 1) Before the extracorporeal circulation, mean PaCO₂ level was 12.1±7.8 mmHg in the priming solution. However, 15 minutes after extracorporeal circulation, the PaCO₂ level was maintained at 35.7±5.7 mmHg. 2) pH in the priming solution was variable from 6.93 to 7.99 (mean 7.45±0.29), but after 15 minutes it was ranged from 7.28 to 7.42 (mean 7.35±0.05). 3) Mean buffer base level in the priming solution was 7.9±3.5 mmol/l. but after 15 minutes, it was 19.6±1.2 mmol/l. 4) Mean PaO₂ level in the priming solution was 667.1±45.6 mmHg, but after 15 minutes, it was 280.7±131.7 mmHg.

Effects of Manually Controlled Ventilation on Gas Exchange during General Anesthesia.: Jung Kook Suh, Ill Sook Suh, Heung Dae Kim; Yeungnam Univ J Med. 1984;1(1):95-100. Published online December 31, 1984; DOI: https://doi.org/10.12701/yujm.1984.1.1.95

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Abstract PDF

In the beginning of anesthetic training, one of the clinical practices that anesthetists have to learn is manually controlled ventilator techniques. The popularity of manually controlled ventilatory techniques has been gradually decreased with increased use for anesthetic ventilators. However it is important and basic for the anesthetists to master manually controlled ventilator techniques skillfully. Recently, we analyzed the arterial blood gas in 30 cases before and during general anesthesia, and studied the effects of the manually controlled ventilation on the pulmonary gas exchange. The results were as follow; 1) Mean value of PaCO₂ during the manually controlled ventilation, 29.9±2.0 mmHg was decreased statistically comparing with that of PaCO₂ before the anesthesia, 39.8±2.8 mmHg. 2) Mean values of pH and HCO₃⁻ during the manually controlled ventilation were 7.48±0.03, 22.2±2.4 mEq/1, respectively and values before the anesthesia were 7.41±0.02, 25.2±1.8 mEq/1, respectively. 3) Mean value of PaO₂ and O₂ saturation during the manually controlled ventilation were 270.0±28.8 mmHg, 99.6±0.2%, respectively and values before the anesthesia were 92.5±4.0 mmHg, 96.9±1.0%, respectively. These results indicates that manually controlled ventilation at our department of anesthesiology produced mild hyperventilatory state. However these were no significant changes in cerebral blood flow and other biochemical parameters.

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