• Journal of Chest Surgery
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• v.17 no.3
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• pp.418-423
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• 1984

Appreciation of the large volume deficits which may occur in surgical or trauma patients due to blood loss has led to vigorous transfusion techniques designed to overt hypovolemic shock and ischemic damage to vital organs which may develop in minutes during the hypovolemic state. In a significant proportion of patients treated with massive rapid blood or fluid transfusion, hypervolemia occurs and life threatening pulmonary edema may develop. Especially, hypervolemia may occur during transfusion for preventing development of the so-called low output syndrome following cardiac surgery. However, the most effective indicator which reveals the adequate level of transfusion is not settled yet. The present study was aimed to compare the effectiveness of the indicators suggested thus far and to determine the most sensitive one. Eight dogs were experimentally studied in terms of left atrial pressure, pulmonary arterial systolic pressure, central venous pressure, mean systemic arterial pressure and heart rate before and after induced hypervolemia with infusion of 600ml heparinized homologous blood. Immediately after induced overtransfusion of the blood, pulmonary arterial systolic pressure increased 75.0%, in omparison with the control before transfusion, left atrial pressure 58.8%, central venous pressure 44.6%, and mean systemic arterial pressure 10.1%, one hour after transfusion, pulmonary arterial systolic pressure 40.0%, left atrial pressure 21.2%, central venous pressure 14.5%, and mean systemic arterial pressure 3.2%, central venous pressure 14.5%, and mean systemic arterial pressure 3.2%, respectively. Heart rate showed no significant change throughout the experiment. These result suggested that the changes of the pulmonary arterial systolic pressure is the most sensitive indicator for detection of hypervolemia during blood transfusion.

• Journal of Chest Surgery
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• v.5 no.2
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• pp.97-106
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• 1972

We will report 6 cases of cardiac tamponade treated surgically at Severance Hospital during the past 9 years from 1964 to 1972 and reviewed literatures on cardiac tamponade. The age of patients was from 13 years to 45 years old. The male was 4 cases and the female 2 cases. The sites of injury were right atrium; 1 case, right ventricle; 2 cases, right ventricle and coronary artery; 1 case, left atrium; 1 case, and left ventricle; 1 case. 2 cases of cardiac tamponade developed following chest injury, 2 cases following pericardiocentesis,1 case due to continuous bleeding from sutured cardiotomy wound of left atrium following open mitral commissurotomy using cardiopulmonary bypass machine, and 1 case due to traumatic penetration of polyethylene catheter through right ventricle to pericardial sac, introduced via right jugular vein in order to monitor the central venous pressure. Central venous pressure was checked preoperatlvely in 5 cases. In all cases, central venous pressure was rised [the range of central venous pressure was 240 to 330 mmHg]. Immediately after operation,central venous pressure lowered to normal [the range was 80-100 mmHg]. Recently serial gas analysis of arterial blood were checked pre- and post-operatively for the evaluation of hemodynamic change of cardiac tamponade, but our data was not enough for evaluation. It should be studied further.

• The Korean Journal of Physiology
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• v.9 no.1
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• pp.45-56
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• 1975

Various factors influencing the lymph flow from thoracic duct were investigated in an attempt to evaluate their contributing degree and the mechanisms. Sixteen mongrel dogs weighing between 10 and 16 kg were anesthetized and polyethylene catheters were inserted into the thoracic duct and femoral veins. Arterial blood pressure, heart rate, central venous pressure, lymph pressure and lymph flow were measured under various conditions. Electrical stimulation of left sciatic nerve, stepwise increase of central venous pressure, manual application of rhythmical depressions onto abdomen, injection of hypertonic saline solution and histamine infusion were employed. Measurement of cental venous pressure was performed through the recording catheter inserted into abdominal inferior vena cava. Changes in central venous pressure were made by an air-ballooning catheter located higher than the tip of the recording catheter in the inferior vena cava. Lymph flow from thoracic duct was measured directly with a graduated centrifuge tube allowing the lymph to flow freely outward through the inserted cannula. The average side pressure of thoracic lymph was $1.1\;cmH_2O$ and lymph flow was 0.40 ml/min or 1.9 ml/kg-hr. Hemodynamic parameters including lymph flow were measure immediately before and after (or during) applying a condition. Stimulation of left sciatic nerve with a square wave (5/sec, 2 msec, 10V) caused the lymph flow to increase 1.4 times. The pattern of lymph flow from thoracic duct was not continuous throughout the respiratory cycle, but was continuous only during Inspiration. Slow and deep respiration appeared to increase the lymph flow than a rapid and shallow respiration. Relationship between central venous pressure and the lymph flow revealed a relatively direct proportionality; Regression equation was Lymph Flow (ml/kg-hr)=0.09 CVP$(cmH_2O)$+0.55, r=0.67. Manual depressions onto the abdomen in accordance with the respiratory cycle caused the lymph flow to increase most remarkably, e.g,. 5.5 times. The application of manual depressions showed a fluctuation of central venous pressure superimposed on the respiratory fluctuation. Hypertonic saline solution (2% NaCl) administered Intravenously by the amount of 10 m1/kg increased the lymph flow 4.6 times. The injection also increased arterial blood pressure, especially systolic Pressure, and the central venous pressure. Slow intravenous infusion of histamine with a rate of 14-32 ${\mu}g/min$ resulted in a remarkable increase in the lymph flow (4.7 times), in spite of much decrease in the blood pressure and a slight decrease in the central venous pressure.

• Journal of Trauma and Injury
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• v.27 no.2
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• pp.33-37
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• 2014

Central venous catheterization through a subclavian approach is indicated for some special purposes but it may cause many complications such as infection, bleeding, pneumothorax, thrombosis, air embolization, arrhythmia, myocardial perforation, and nerve injury. A case involving a mistaken central venous catheterization into the right vertebral artery through the subclavian artery is presented. A 33-year-old man who had deteriorated mentality after head injury underwent an emergency craniotomy for acute epidural hematomas on the right frontal and temporal convexities. His mentality improved rapidly, but he complained of continuous severe pain in the right posterior neck even though he had no previous symptom or past medical history of such pain. Three-dimensional cervical spine computed tomography (3D-CT) was performed first to rule out unconfirmed cervical injuries and it revealed a linear radiopaque material intrathoracically from the level of the 1st rib up to the level of C6 in the right vertebral foramen. An additional neck CT was performed, and the subclavian catheter was indwelling in the right vertebral artery through right subclavian artery. For the purpose of proper fluid infusion and central venous pressure monitoring, the subclavian vein catheterization had been performed in the operation room after general anesthesia induction before the craniotomy. Sufficient anatomical consideration and prudence is essential because inadvertent arterial cannulation at a non-compressible site is a highly risky iatrogenic complication of central venous line placement.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.81-85
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• 2021

Central venous catheter (CVC) insertion is commonly used in the operating room and intensive care unit to monitor central venous pressure and secure an intravenous route to deliver medications and nutritional support that cannot be safely infused into peripheral veins. However, CVC insertion may be associated with serious complications such as arterial puncture, hematoma, pneumothorax, hemothorax, catheter infections, and thrombosis. Several methods have been recommended to prevent these complications. Here we report a case of massive hemothorax caused by attempts of CVC insertion into the internal jugular vein and subclavian vein in a patient with multiple trauma. CVC placement should be performed or supervised by an experienced physician to decrease the incidence of CVC-related complications. CVC insertion under ultrasound guidance is recommended.

• The Korean Journal of Physiology
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• v.5 no.2
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• pp.71-78
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• 1971

Anesthetized dogs were tilted from horizontal to the upright and head down position. Tilting to the upright position was followed by an increase in heart rate. In the head down position a decreased heart rate was obtained. The arterial blood pressure was decreased in the upright position and was decreased markedly in the head down position. The central venous pressure was decreased in the upright position and was markedly decreased down to the negative pressure in the head down position. The respiratory rate was slightly increased in the upright position comparing to that in the horizontal position. No remarkable changes were noted in the head down position. From the above results the following factors were discussed The decreased arterial blood pressure during the upright position was supposed to be the secondary effect from the diminished venous return that was suggested by the decreased central venous pressure. The decreased arterial blood pressure in the head down position was also supposed as the above reason as the diminished central venous pressure during the tilt. In addition the cardioinhibitory effects originated from the baroreceptors might have been operated during head down tilting. In the heart rate there was slight tachycardia in the upright position this was assumed as the abolished cardioinhibitory impulses from the baroreceptor in the upright position. On the contrary, despite of the decrease of arterial blood pressure in the head down position as well as in the upright, the bradycardia have been appeared. This was suggestive of cardioinhibitory impulses from the baroreceptors which was stretched during head down tilting. From the above findings there is a possibility of continous cardioinhibitory responses during head down tilting for this kind of the short period of 10 minutes which was chosed in this study.

• The Korean Nurse
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• v.6 no.2 s.28
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• pp.49-51
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• 1967

• The Korean Journal of Physiology
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• v.3 no.2
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• pp.25-31
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• 1969

Effects of graded increase of positive lung inflation upon heart rates and arterial blood pressure were observed in the anesthetized dogs to analyze the mechanical and neural regulatory factor in response to the positive inflation of the lung. The results obtained were summarized as followings: 1) When the low grade of positive lung inflation was employed under the mild to moderate anesthesia, central venous pressure was linearly increased while heart rate was decreased. After bilateral vagotomy, central venous pressure was obviously increased while heart rate was constant. 2) When the high degree of positive lung inflation was employed, changes of central venous pressure and heart rate were not significant. 3) The low grade of intrapulmonary pressure increase caused reflex tachycardia in phase 2 and overshooting in phase 4 in response to the systemic arterial blood pressure change. 4) On the other hand, the high degree of intrapulmonary pressure increase caused paradoxical bradycardia in phase 2 and lack of overshooting in phase 4 in response to the systemic arterial blood pressure change. 5) It may be noted that the experimental model employed in the present study is a useful tool to evaluate and analyze the neural and mechanical regulatory factor in response to the graded increase of the positive lung inflation.

• Journal of Korean Academy of Nursing
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• v.36 no.2
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• pp.353-360
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• 2006

Purpose: This study was done to investigate the effects of backrest elevation of 0 degree and 30 degrees that minimize the risk of increasing ICP when CVP is measured. Methods: Subjects were sixty-four patients who stayed in the neurosurgical intensive care unit after brain surgery at two university-based hospitals. CVP, blood pressure, heart rate and ICP were measured along with position changes in order of backrest position with primary 30 degrees backrest position, 0 degree backrest position and secondary 30 degrees backrest position. For data analysis, one-group, repeated-measures analysis of variance design was used in SAS program. Results: Backrest elevations from 0 degree to 30 degrees did not alter the CVP without increasing the ICP. Therefore, 30 degrees backrest position is a preventive position without increasing ICP. Conclusion: 30 degrees backrest position might be appropriate for brain injury patients when CVP is measured.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.22-32
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• 1990

Postoperative cardiac performance of cyanotic congenital heart disease is somewhat different from that of other cardiac diseases. For the evaluation of postoperative cardiac performance in the cyanotic congenital heart disease we measured cardiac output by thermodilution technique at 1, 4, 8, 12, 16, 20, 24, 36, 48 postoperative hours in 14 patients operated from Feb. 1989 to Nov. 1989 in The Department of Thoracic and Cardiovascular Surgery, Seoul National University Children`s Hospital. At the same time, we checked left atrial pressure [LAP], central venous pressure [CUP], and mixed venous oxygen saturation [SvO2] to detect correlation between them. Immediate postoperative cardiac index was 3.585 $\pm$ 0.945 L/min/m2, and it decreased maximally to 3.322$\pm$1.007 L/min/m2 at postoperative 16 hours. After then it increased and stabilized from 36 hours after operation, and its value was 4.426$\pm$1.358 L/min/m2. There were no correlations between cardiac index and left atrial pressure or central venous pressure. Between mixed venous oxygen saturation and cardiac index, there was no correlation in the early postoperative period but after postoperative 16 hours, there was significant correlation between them and correlation coefficients were 0.573 [16hrs], 0.743 [20hrs], 0.436 [24hrs], 0.560 [36hrs], 0.636 [48hrs], respectively. From these results, we concluded that in the corrective surgery of cyanotic congenital heart disease, cardiac performance was depressed in the early postoperative period. It improved from postoperative 16 hours, and stabilized from 36 hours after operation. During early postoperative period, mixed venous oxygen saturation should not be used as a predictor of cardiac performance but it could be used as a predictor of cardiac performance from 16 hours after operation.