Jung Ju Choi

Stewart's physicochemical approach in neurosurgical patients with hyperchloremic metabolic acidosis during propofol anesthesia.

There is both in vitro and clinical evidence that high-dose propofol can inhibit mitochondrial respiration, resulting in metabolic acidosis. The purpose of this study was to evaluate the effects of propofol anesthesia on the acid-base status in neurosurgical patients with large amount of normal saline administration. Thirty patients undergoing clipping of cerebral aneurysm were randomly assigned to receive propofol (n=15) or isoflurane (n=15). Propofol dose (mean±standard error) infused for maintenance was 5.7±0.2 mg/kg/h in propofol group. Acid-base parameters such as PaCO2, pH, serum bicarbonate concentration, standard base excess, serum electrolyte concentration, total protein, albumin, lactate, and phosphate were measured before and 4 hours after the induction of anesthesia, and after surgery. The apparent strong ion difference (SIDa), the effective SID (SIDe), and the amount of weak plasma acid were calculated using the Stewart equation. There were no significant differences in pH, PaCO2, bicarbonate, and lactate between 2 groups throughout the whole investigation period. After surgery, standard base excess significantly decreased in both groups without intergroup difference. SIDa and SIDe significantly decreased in both groups, and lactate and strong ion gap significantly increased after surgery in propofol group, but there were no significant differences between 2 groups. Both propofol and isoflurane were associated with hyperchloremic metabolic acidosis in neurosurgical patients with large amount of normal saline administration. The acid-base balance between the 2 anesthetics was similar using Stewarts physicochemical approach.

Perioperative Concerns for Profound Metabolic Alkalosis During Kidney Transplantation: A Case Report

Introduction Profound metabolic alkalosis is an uncommon consideration for the anesthetic management of kidney transplantation. Serum total carbon dioxide content and complex electrolyte abnormalities might be important diagnostic clues for the presence of metabolic alkalosis in the absence of arterial blood gas analysis. Case Presentation A 34-year-old female visited Gachon University Gil Medical Center, Incheon, South Korea during year 2015. She experienced aggravated renal function due to chronic hypokalemia and severe hypochloremic metabolic alkalosis, induced by laxative abuse, and underwent ABO incompatible kidney transplantation. Serum total carbon dioxide content remained high (about 60 mEq/L) over eight months of monthly follow-up prior to kidney transplantation. Conclusions The authors described their anesthetic experience of profound metabolic alkalosis with complex electrolyte abnormalities and provided a review of relevant literature.

Anesthetic experience of an adult male with citrullinemia type II: a case report

BackgroundCitrullinemia type II is an autosomal recessive urea cycle disorder and a subtype of citrin deficiency. However, the management of recurrent hyperammonemia with neurologic symptoms in patients with citrullinemia type II is quite different from the management of other types of urea cycle disorders. In pats with citrullinemia type II, regional anesthesia might be a good choice for the early detection of hyperammonemic symptoms and addressing psychic stress.Case presentationA 48-year-old male with adult onset citrullinemia type II was scheduled for urethral scrotal fistula repair. During the first operation, spinal anesthesia with conscious sedation using dexmedetomidine was used, a second operation was performed after confirmation of infection control and a stable neurologic condition. In this patient, dietary planning with close monitoring of serum ammonia level and close observation of neurologic conditions might lead to successful perioperative care.ConclusionFor anesthesia of patients with adult onset citrullinemia type II, close monitoring of neurologic signs and serum ammonia are important to reduce neurologic complications induced by hyperammonemia. Regional anesthesia with a proper dietary plan might reduce patient stress and prevent metabolic tragedy.

Preanesthetic mortality prediction in diabetics undergoing major lower limb amputation at a tertiary referral hospital: Implications of preoperative echocardiographic and laboratory values.

PURPOSE Cardiac comorbidities in patients undergoing amputation due to diabetic foot ulcer are associated with high mortality rates. The authors investigated whether preanesthetic echocardiographic and laboratory values can predict inhospital mortality in type II diabetes patients undergoing major lower limb amputation under spinal anesthesia. METHODS The archived medical records of 215 patients were retrospectively reviewed. Demographic data and preoperative laboratory and transthoracic echocardiographic values were analyzed by multivariate logistic regression for factors independently associated with inhospital mortality. RESULTS Of the 215 patients, 12 died in hospital after amputation. Preoperative hemoglobin level (hazard ratio, 0.082; 95% confidence interval, 0.013-0.509; P = .007) and left ventricular ejection fraction (hazard ratio, 0.874; 95% confidence interval, 0.779- 0.981; P = .023) were found to be significant predictors of inhospital mortality. CONCLUSIONS Preoperative hemoglobin level and left ventricular ejection fraction are highly correlated with inhospital mortality in type II diabetes patients undergoing major lower extremity amputation under spinal anesthesia.

Anesthetic management of a patient with pulmonary arteriovenous malformation under total intravenous anesthesia - A case report -

A 23-year-old woman with pulmonary arteriovenous malformation was scheduled for open reduction and internal fixation due to her mandible fracture. Total intravenous anesthesia using propofol and remifentanil was selected as the anesthetic method in order to avoid the inhibition of hypoxic pulmonary vasoconstriction and the exacerbation of intrapulmonary shunting. After the standard monitoring devices were applied, anesthesia was then induced and maintained with a target controlled infusion of propofol and remifentanil in the range of 2.5-3.0 microg/ml and 2-3 ng/ml, respectively. Anesthesia was performed uneventfully and the patient was discharged without complication.