Acute and Critical Care

The Diagnosis and Pharmacologic Management of Arrhythmia: Heon Kil Lim; Korean J Crit Care Med. 2002;17(2):61-65.

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Abstract PDF: Arrhythmias are categorized as due to abnormal impulse formation, abnormal impulse propagation or combined abnormalities of impulse formation and propagation. The primary tools used in the diagnosis of cardiac arrhythmias are the history, physical examination,12-lead electrocardiogram,24-hour continuous electrocardiographic recording, exercise test,intermittent electrocardiographic recording and clinical electrophysiologic study. Optimal management of cardiac arrhythmias requires knowledge of their mechanism,etiology, natural history and effect on the hemodynamic state.And the antiarrhythmic treatment must be monitored closely for its initial and continued effectiveness and for adverse effects.

History and Background of Arterial Blood Gas Analysis: Jin Mo Kim; Korean J Crit Care Med. 2002;17(2):66-69.

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Abstract PDF: No abstract available.

The Interpretation of Respiratory Acidosis and Respiratory Alkalosis: Jeong Sup Song; Korean J Crit Care Med. 2002;17(2):70-74.

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Metabolic Disorders of Acid Base Balance: Jin Suk Han; Korean J Crit Care Med. 2002;17(2):75-86.

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Strong Ion Difference and Base Excess: Su Kil Park; Korean J Crit Care Med. 2002;17(2):87-90.

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Diagnosis of Mixed Acid-Base Disturbances: Myoung Hoon Kong; Korean J Crit Care Med. 2002;17(2):91-94.

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Abstract PDF: No abstract available.

The Effects of Propofol on Blood-Brain Barrier Disruption with Mannitol Infusion in Cervical Sympathetic Nerve Blocked Rats: Jin Young Lee, Soo Han Yoon, Jae Hyung Kim, Yun Jeong Chae, Young Joo Lee, Jin Soo Kim, Bong Ki Moon; Korean J Crit Care Med. 2002;17(2):95-99.

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Abstract PDF: BACKGROUND
Blood brain barrier disruption (BBBD)increases therapeutic agents delivery to brain diseases.Increasing the delivery of therapeutic drugs to the brainimproves out come f or patients with brain tumors.Cervical sympathetic chain block can increase the degree of mannitol induced blood brain barrier disruption in rats.Anesthetic agents may modify hyperosmolar blood brain barrier disruption.Therefore we evaluated the effecfs of pentobarbital and propofol on mannitol induced blood brain barrier disruption(BBBD)in cervical sympathetic nerve blocked rats.
METHODS
14 male Sprague-Dawley rats were divided into 2 groups.Intravenous pentobarbital (group 1,n=7)and propofol (group 2,n=7)were administrated.Rats was blocked with 0.5% bupivacaine on right cervical sympathetic chain.All rats received 37degrees C,25%mannitol (1.75 g/kg) via right carotid artery.BBBD was estimated by Evans blue staining in cerebral hemisphere.
RESULTS
Both groups showed BBBD in right side hemisphere and there was no significant difference between group 1 and group 2 in right side hemisphere.
CONCLUSIONS
The results suggest that propofol could be used to be anesthetics for BBBD in cervical sympathetic blocked rats.

Endoventricular Circular Patch Plasty and Intra-operative and Post-operative Care for Patients with Ischemic Cardiomyopathy: Jin Hee Kim, Byung Moon Ham, Yong Lak Kim, Yoon Seok Jeon, Sung Hee Han, Jae Sang Sung, Ki Bong Kim, Hyeong Ryul Kim; Korean J Crit Care Med. 2002;17(2):100-106.

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Abstract PDF: BACKGROUND
Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy.
METHODS
EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit.
RESULTS
Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively.
CONCLUSIONS
EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.

The Direct Myocardial Depressant Effect of Naloxone in Vitro: Mechanical and Electrophysiological Actions: Ki Jun Kim, Haeng Cheol Lee, Ki Young Lee, Ji Young Kim, Sueng Teck Joo, Wyun Kon Park; Korean J Crit Care Med. 2002;17(2):107-118.

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Abstract PDF: BACKGROUND
Naloxone,an opioidant agonist, has been s hown t o have a c ar di ovascular pressor effect in states of hemorrhagic and endotoxic shock.We determined the direct inotropic effect of naloxone using guinea pig right ventricular papillary muscles.
METHODS
With institutional approval,isometric contractile force was measured in normal and 26mM K+ Tyrode's solution at various stimulation rates.Normal and slow action potentials (APs) were measured with conventional microelectrode technique.The effects of naloxone on sarcoplasmic recticulum function were evaluated by measuring rapid cooling contractures (RCCs)in normal Tyrode 's solution and rested-state (RS)contraction in low Na+ (25 mM)Tyrode's solution.Patch clamp study was performed to examine the direct effect on Ca2+ current in myocytes.
RESULTS
Naloxone (50,100,200 micro M)caused dose-dependent depression of peak force and maximal rate of peak force (dF/dt-max)by 30,50 and 70%,respectively.Modest depression was shown in RS contraction in low Na+ Tyrode's solution.In 26 mM K+ Tyrode's solution,100 micro M naloxone markedly depressed late force development.100 micro M naloxone depressed RCCs by 20%. While 100 micro M naloxone did not alter amplitude or dV/dt-max in normal and slow APs at 0.25 Hz, AP duration was prolonged significantly.In patch clamp study,50 micro M naloxone depressed Ca2+ current by 50%.
CONCLUSIONS
Naloxone depresses contractile force.Myocardial depressant effect partly seems to be caused by depressed Ca2+ influx through cardiac membrane.Rapid release of Ca2+ from the sarcoplasmic reticulum by depolarization and release by rapid cooling seems to be minimally affected.

Midodrine for the Treatment of Hypotension in a Tetraplegic Patient with Cervical Cord Injury in ICU: A case report: Dong Woo Han, Shin Ok Koh, Yong Keyong Lee, Man Woo Lee; Korean J Crit Care Med. 2002;17(2):119-122.

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Abstract PDF: Cervical spinal cord injury results in significant dysfunction of the sympathetic nervous system. Reduced sympathetic activity below the level of spinal cord injury is associated with low resting blood pressure,orthostatic hypotension,and reflex bradycardia.Hypotension can be treated with vasoactive agents,such as dopamine,epinephrine,norepinephrine, and phenylephine .Orally administered midodrine is an alpha adrenergic receptor agonist that increases blood pressure with vasoconstriction.Its action is fast and effective in treating hypotension in patients with spinal cord injury,and it has less severe side effects.A 70-year-old tetraplegic patient with fracture and dislocation of C6-7 after a motor vehicle accident was admitted to ICU and underwent anterior cervical intervertebral body fusion.Symptomatic hypotension following postural changes was treated with intravenous infusion of dopamine,but it was difficult to reduce the dose of dopamine without causing severe hypotension.Midodrine was prescribed and the patient was well tolerated without any adverse effect.With adequately maintained blood pressure,intravenous infusion of dopamine was successfully switched to the oral midodrine.This case suggests that the midodrine is effective for the treatment of hypotension in tetraplegic patients with spinal cord injury and enables patients to participate in early rehabilitation therapies.

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