• Journal of Chest Surgery
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• v.23 no.1
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• pp.32-40
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• 1990

Surgical correction of congenital cardiac defects in infants and children with an elevated pulmonary arterial pressure or pulmonary vascular resistance carries a significant early postoperative mortality. And accurate assessments of cardiac output is critically important in these patients. From April 1988 through September 1989, serial measurements of cardiac index, ratio of pulmonary-systemic systolic pressure, ratio of pulmonary-systemic resistance, central venous pressure, left atrial pressure, and urine output during the first 48 hours after the cardiac operation were made in 30 congenital cardiac defects associated with pulmonary hypertension. Cardiac index showed significant increase only after 24 hour postoperatively and this low cardiac performance in the early postoperative period should be considered when postoperative management is being planned in the risky patients. There were no variables which showed any significant correlation with cardiac index. In 12 cases[40%], pulmonary hypertensive crisis developed during the 48 hours postoperatively, and they were treated with full sedation, hyperventilation with 100 % 0y and pulmonary vasodilator infusion. In all patient with preoperative pulmonary hypertension, surgical placement of a pulmonary artery catheter is desirable to allow prompt diagnosis of pulmonary hypertensive crisis and to monitor subsequent therapy.

• Journal of Trauma and Injury
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• v.32 no.4
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• pp.238-242
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• 2019

Extreme acidosis is a life-threatening physiological state that causes disturbances in the cardiovascular, pulmonary, immune, and hematological systems. Trauma patients commonly present to the operating room (OR) in hypovolemic shock, leading to tissue hypoperfusion and the development of acute metabolic acidosis with or without a respiratory component. It is often believed that trauma patients presenting to the OR in severe metabolic acidosis (pH <7.0) will have a nearly universal mortality rate despite aggressive resuscitation and damage control. The current literature does not include reports of successful resuscitations from a lower pH, which may lead providers to assume that a good outcome is not possible. However, here we describe a case of successful resuscitation from an initial pH of 6.5 with survival to discharge home 95 days after admission with almost full recovery. We describe the effects of acute acidosis on the respiratory and cardiovascular systems and hemostasis. Finally, we discuss the pillars of management in patients with extreme acute acidosis due to hemorrhage: transfusion, treatment of hyperkalemia, and consideration of buffering acidosis with bicarbonate and hyperventilation.

• Korean Journal of Psychosomatic Medicine
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• v.17 no.2
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• pp.45-51
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• 2009

Pulmonary diseases distress millions of people worldwide. Numerous studies have shown an association between pulmonary disease and psychiatric disorders. Despite this, little is known about the treatment of psychiatric disorder in patients with pulmonary disease. The three main goals of this article are 1) to discuss the major disorders such as asthma, chronic obstructive pulmonary disease, hyperventilation, tuberculosis, lung cancer that most clinicians see in practice, 2) to provide an information about psychiatric treatment such as anxiety, depression, psychosis in pulmonary disease, and 3) to provide some clinically relevant suggestions about pharmacologic interactions between pulmonary and psychotropic drugs.

• Korean Journal of Psychosomatic Medicine
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• v.2 no.1
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• pp.34-45
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• 1994

The author reviewed psychosomatic aspects of bronchial asthma including psychological aspect of bronchial asthma, patients' reactions to illness, reactions of therapists and families, effect of bronchial asthma on mental function, psychotherapy and pharmacotherapy. The therapists' understanding of these aspects is likely to be helpful in their predicting and understanding the type of adaptation their asthmatic patients are making to their illness. Thus, the therapists need to recognize the asthmatics' psychological needs. They also should understand the vicious cycle of anxiety-hyperventilation-panic-fear-avoidance in patients with bronchial asthma and should try to break this cycle. To make it possible, the patients' panic-fear level should be assessed and sometimes it will require psychiatrists' advice. On the other hand, the asthmatics should be trained to be shaped to relate subjective feeling of pulmonary function with objective pulmonary measures, which will enable these patients to perceive their early symptoms and to cope with asthma attack effectively. The therapists need to pay attention to their emotion during evaluation and treatment of patients with bronchial asthma, because they are less likely to perceive stress and express their emotion.

• Journal of The Korean Dental Society of Anesthesiology
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• v.2 no.1 s.2
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• pp.33-37
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• 2002

The oculo-cerebro-renal syndrome of Lowe (Lowe syndrome) is an X-linked recessive disorder involving the eyes, nervous systems, and kidneys. The clinical manifestation of this syndrome is characterized by congenital cataracts, glaucoma, seizure disorder, psychomotor growth retardation, hypotonia, renal tubular acidosis, aminoaciduria, rickets, and osteoporosis. We report a 5-year old boy underwent general anesthesia for the treatment of multiple dental carries. During intraoperative period, marked metabolic acidosis was noted and such acidosis was partially corrected by hyperventilation. We suggest that patients with Lowe's syndrome should be attention and treated to possible anesthetic hazards such as metabolic acidosis due to renal tubular dysfunction, rise of intraocular pressure in patient with glaucoma, the fragility of the bone structures due to rickets and osteoporosis.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.944-950
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• 1989

Children with congenital cardiac defects associated with high pulmonary artery pressure may die despite accurate surgery. Postoperative mortality and morbidity have been attributed to acute rises in pulmonary artery pressure and resistance. Acute pulmonary hypertensive crisis is defined as a paroxysmal event in which pulmonary arterial systolic pressure rises to or above systemic levels followed by a rapid fall in systemic pressure and a minor pulmonary hypertensive event is defined as an acute rise in pulmonary arterial pressure to more than 80 % of systemic levels but without a fall in systemic pressure. From Oct. 1988 to Jul. 1989, we experienced 23 patients who showed many pulmonary hypertensive crises after operation in the Department of Thoracic and Cardiovascular Surgery, Seoul National University Children\ulcorner Hospital. Their preoperative PAP/SAPs were 53 to 123 %[mean 93.3%] and diagnoses were VSD[7], TAPVR[5], TGA[4], AVSD[3], MS[1], DORV[1], Truncus arteriosus[1], and AP window[l]. There were 9 deaths among 23 patients and they showed many pulmonary hypertensive crisis episodes during postoperative intensive care, which was managed by sedation, hyperventilation, oxygen, and acidosis correction and which decreased after using tolazoline. In view of our experience, we recommend that pulmonary artery pressure should be monitored in congenital heart defected patient with preoperative pulmonary hypertension to confirm and to manage the pulmonary hypertensive crisis accurately and using tolazoline is helpful in the treatment of pulmonary hypertensive crisis.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.209-213
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• 2010

Anxiety and fear is two main factors that keep patients from going to dental clinic. Especially, patients may feel implants operations are more traumatic. Intravenous conscious sedation for dental treatment can make patient comfortable and relaxable. Midazolam is more popular for sedation for dental treatment, but target-controlled infusion (TCI) of propofol and remifentanil is gaining wide popularity. A 54-year-old female patient who had severe dental phobia was referred to our dental hospital. She had past history of 2 times of hyperventilation and syncope during dental treatment. The patient showed a lot of dental anxiety and fear to dental treatments and stress reduction protocol was needed. We administered intravenous conscious sedation using target controlled infusion system with remifentanil and propofol. During sedation, we monitored the status of consciousness with bispectral index and vital signs. Dental treatment could be finished successfully without any problems.

• The Journal of the Korean dental association
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• v.53 no.8
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• pp.530-537
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• 2015

Conceptually, the emergency is classified as an urgency and an emergency. The Urgency is not immediately life threatening, but could become so if not resolved promptly. So, it requires prompt patient care same as in the emergency situation. However, the emergency is immediately life threatening and requires immediate action, such as calling 119 and basic life support. Most medical emergencies in the dental clinic cases are urgencies. The incidence of true emergencies is approximately 1/1,000,000. Adequate managing medical urgencies are important because the chance of encountering medical emergencies in the dental clinic is high and higher these days especially because of rapidly aging Korean society. Many dentists indicate that many dentists feel difficulties to recognize and treat medical problems. This paper reviews the concept of medical emergencies and how to cope with commonly occurring urgencies in the dental clinic such as loss of consciousness, hypoglycemia, hyperventilation syndrome. The best treatment for medical urgencies and emergencies in the dental clinic is prevention. Also, it is required to make preparation for emergency situations such as CPR education for dentists and being well-acquainted with equipment and drugs for the emergency care as well as to systemic medical evaluation, patient monitoring, and sedations for controlling patient's anxiety and pain. In this paper, simple algorithms based on guidelines for common urgencies in the dental clinic are suggested. In conclusion, every dentist has competencies to do the urgency care adequately and basic life support. Also, advanced cardiac life support is strongly recommended when sedation is performed in the clinic.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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• pp.164-171
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• 2011

Altered consciousness may be the first clinical sign of a serious medical problem that requires immediate and intensive therapy to maintain life. There are many causes of the loss of consciousness in the dental office setting, such as, vasodepressor syncope, drug administration or ingestion, orthostatic hypotension, epilepsy, hypoglycemic reaction, acute adrenal insufficiency, cerebrovascular accident, hyperglycemic reaction, acute myocardial infarction, acute allergic reaction and hyperventilation. This is a case report of syncope and coma during endodontic treatment of a maxillary third molar under local infiltration anesthesia in multiple medically compromised patient. The main cause was thought to be hypoglycemic reaction. The patient was transferred to the medical emergency room and cared properly by the emergency medical physicians. The prognosis was good.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.2
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• pp.119-126
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• 2014

Difficulty in breathing can be very disconcerting to a patient who is conscious yet unable to breath normally. The common causes of acute respiratory distress include hyperventilation, vasodepressor syncope, asthma, heart failure, and hypoglycemia. In most of these situations, the patient does not exhibit respiratory distress unless an underlying medical disorder becomes acutely exacerbated. Examples of this include acute myocardial infarction, anaphylaxis, cerebrovascular accident, hyperglycemia, and hypoglycemia. A major factor that leads to the exacerbation of respiratory disorders is undue stress, either physiologic or psychologic. Psychologic stress in dentistry is the primary factor in the exacerbation of preexisting medical problems. Therefore, the most dental patient should be cared gently as the stress reduction protocol. This is a case report of acute respiratory distress with vasodepressor syncope during alginate impression taking of mandibular teeth in a long-standing temporomandibular joint dislocated 93-years-old pneumonic patient.