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S T Fung

Publications and source records attributed to S T Fung.

18 recordsLinked to original sources
PubMed2001

Bullous eruptions caused by extravasation of mannitol--a case report.

Extravasation is one of the common complications seen with intravenous infusion. We bring forward a case of subcutaneous mannitol extravasation, which caused swelling and multiple cutaneous bullous eruptions in the hand and forearm during craniotomy. Treatment consisting of elevation of the affected extremity and application of silver sulfadiazine ointment twice daily to the injured area was successful. The possible mechanisms relevant to extravasation and its tissue damage are reviewed and discussed. Selecting proper intravenous infusion site, using pliable catheters and frequent inspection are important steps for prevention of extravasation.

Aged↗
PubMed1999

Aspiration and transtracheal jet ventilation with different pressures and depths of chest compression.

OBJECTIVE: To evaluate aspiration prophylaxis during cardiopulmonary resuscitation (CPR) using transtracheal jet ventilation (TJV) with different pressure-depths of chest compression and chest compression alone without mechanical ventilation. DESIGN: Prospective, animal study. SETTING: Animal research laboratory, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan. SUBJECTS: Mongrel dogs (n = 10) weighing 8 to 12 kg. INTERVENTIONS: Eight mongrel dogs were anesthetized, paralyzed, and ventilated transtracheally with a jet ventilator at frequencies varied from 600 to 10 cycles/min. The airway pressures below and above the jetting port were measured. The mouth of the dog was filled with barium and chest radiographs were taken 10 mins after chest compression with 20-pound pressure and 5-cm depth in group 1 and 10-pound pressure and 3-cm depth in group 2 at each different jet frequency. Two additional dogs underwent the same procedures but received only chest compression without TJV. MEASUREMENTS AND MAIN RESULTS: Pulmonary aspiration was not noted in the chest radiographs from either group. The airway pressure changes between groups were not significantly affected by difference in pressures and depths of chest compression at the same jetting frequency. However, pulmonary aspiration occurred in the two dogs that received chest compression alone without TJV. CONCLUSIONS: Application of TJV during chest compression with different pressures and depths caused no pulmonary aspiration in dogs at frequencies between 600 and 10 cycles/min. The protection against aspiration disappeared if the dogs received only chest compression without TJV. The mechanism of preventing pulmonary aspiration in TJV is thought to be due to forceful unidirectional gas outflow through the larynx and higher airway pressure in the carina than in the upper airway. The airway pressures were not affected by different chest compression pressures and depths because the larynx stayed open during TJV and the air outflow could freely move out without increasing the pressure in the airway.

Animals↗
PubMed1998

Early recognition of unsuspected malignant hyperthermia and successful management of serve myoglobinuric renal failure in subsequent rhabdomyolysis: a case report.

Malignant hyperthermia (MH) is a rare inherited disorder of skeletal muscle, its inheritance being autosomal dominant and its mutant gene located on chromosome 19. MH is occasionally observed during general anesthesia when using some special triggering agents. In the susceptible patient, it presents with a fulminant skeletal muscle hypermetabolic crisis and proceeds to serve rhabdomyolysis. Once rhabdomyolysis is established, acute renal failure is not an inevitable consequence, yet it is the fatal complication if the condition is not appropriately managed. We describe a case of acute renal failure in the setting of rhabdomyolysis in unsuspected MH, resulting in full recovery after intermittent hemodialysis. In this case, we emphasize the importance of early recognition of MH and the favorable prognosis of subsequent myoglobinuric renal failure if treated appropriately.

Acute Kidney Injury↗
PubMed1995

Use of a single lumen endotracheal tube and continuous CO2 insufflation in transthoracic endoscopic sympathectomy.

BACKGROUND: Transthoracic endoscopic sympathectomy (TES) is an accepted standard surgical treatment for palmar hyperhidrosis. For anesthetic management, a double lumen endobronchial tube is usually used to deflate the lung on the operative side. Recently we have applied continuous insufflation of carbon dioxide (CO2) into the pleural cavity to merely compress one lung while ventilating both lungs with a conventional single lumen endotracheal tube. METHODS: We have studied 45 patients (ASA I and II) who underwent bilateral TES, Thirty-three were ventilated by single lumen tube and the other 12 by double lumen endobronchial tube with one lung ventilation. In both groups I and II, CO2 was insufflated slowly through the scope to a intrapleural pressure of 20 cm H2O. Both lungs were ventilated with peak pressure of less than 20 cmH2O at tidal volume of 5-12 ml/kg at 10-16 beats/min. RESULTS: In these patients, no CO2 retention was noted. Oxygenation and cardiovascular stability were maintained and there were no complications. In the double lumen series, we found that oxygen saturation was less uniform and less stable than those in the single lumen series. CONCLUSIONS: It is concluded that the use of single lumen endotracheal tube with continuous insufflation of CO2 in TES is easy, simple and safe.

Adolescent↗
PubMed1994

Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis.

OBJECTIVE: Transthoracic endoscopic electrocauterization of the sympathetic chain for palmar hyperhidrosis is presented. DESIGN: A retrospective study of 180 patients during a 2-year period was carried out. The duration of follow-up was from 2 to 12 months. SETTING: General community, referral center, and hospitalized care. PATIENTS: This study was carried out in 180 patients (116 female and 64 male). The age distribution was between 13 and 43 years (mean age, 21.6 years). They complained of palmar hyperhidrosis without other underlying diseases. INTERVENTIONS: One-stage bilateral surgery except for three patients with unilateral pleural adhesions. MAIN OUTCOME MEASURES: Patients were interviewed 1 week after surgery and then they were contacted by a questionnaire about improvement of hyperhidrosis and complications. RESULTS: This procedure shows a success rate in 98% of the patients. No pneumothorax requiring a chest tube drainage and no Horner's syndrome were recorded. The most common side effect was compensatory sweating in 70% of these patients. CONCLUSION: This procedure is effective, simple, and requires only an overnight study. It is recommended as the method of choice for surgical treatment of upper extremity hyperhidrosis.

Adaptation, Physiological↗
PubMed1990

Electro-acupuncture and postoperative emesis.

One hundred unpremedicated female patients of ASA grade 1 or 2 who underwent laparoscopy as outpatients were allocated randomly to one of four groups. All patients received general anaesthesia with fentanyl, thiopentone, halothane, nitrous oxide and oxygen; suxamethonium was given to facilitate tracheal intubation. In the recovery room, group 1 (control) received no treatment; group 2 received electro-acupuncture at the P6 point (Neiguan) on the right side for 15 minutes, group 3 received transcutaneous electrical nerve stimulation at the P6 point on the right side for 15 minutes and group 4 received prochlorperazine 5 mg intravenously. Any act of vomiting, including dry retching, during the first 3 postoperative hours was regarded as postoperative emesis. The incidence of postoperative emesis was 11/25 (44%) in group 1, 3/25 (12%, p less than 0.05) in group 2, 9/25 (36%) in group 3, and 3/25 (12%, p less than 0.05) in group 4. Our results suggest that electro-acupuncture is as effective as prochlorperazine, and may be better than transcutaneous electrical nerve stimulation, in reducing postoperative emesis.

Adolescent↗
PubMed1989

[Effects of labetalol and nitroglycerin during induction of anesthesia and endotracheal intubation in hypertensive patients].

We have compared the effectiveness of labetalol and nitroglycerin for the control of hemodynamic responses to laryngoscopy and endotracheal intubation in hypertensive patients. Twenty four patients with hypertension were randomly assigned to labetalol and nitroglycerin treatment groups, each consisting 12 patients. The labetalol group showed decrease of both systolic and diastolic pressure, minimum raise in heart rate (6.49%) and lowering of RPP (rate pressure product). Nitroglycerin group showed decrease of systolic pressure but diastolic pressure increased 5.76%, heart rate increased 32.27% and RPP increased 19.4%. The result showed that although both drugs blunted the hypertensive response to endotracheal intubation, intravenous labetalol seemed safer and more effective than nitroglycerin to attenuate the hypertensive response to laryngoscopy and intubation in hypertensive patients.

Adult↗
PubMed1989

Antagonism of the respiratory and analgesic effect of fentanyl produced by aminophylline.

Low-dose aminophylline may reverse the respiratory depression caused by morphine and fentanyl. High-dose aminophylline may decrease an animal's tolerance to painful stimulation. We postulated that fentanyl combined with low-dose aminophylline could result in adequate analgesia without the side-effect of respiratory depression. Twelve healthy volunteers were randomly divided into group A and group B each consisting of six persons. Group A received fentanyl 3 ug/kg and group B received fentanyl 3 ug/kg plus aminophylline 3 mg/kg iv. Arterial carbon dioxide tension (PaCO2) was taken as an index of respiratory status and the analgesic effect of fentanyl was estimated by measuring changes in maximum pain tolerance (MPT) using a pressure clamp device. The results showed that 3 mg/kg of aminophylline significantly alleviated the respiratory depression effect of fentanyl 15 and 25 min post-injection (P less than 0.05), without attenuation of its analgesic effect. The severe hemodynamic disturbance and acute reversal of analgesia, which may be induced by naloxone, were not observed. Our results suggest that aminophylline safely reverses the respiratory depression caused by fentanyl.

Adult↗
PubMed1989

Effect of preoperative fasting time on gastric volume and pH.

In order to asses the effect of preoperative fasting time on gastric volume and pH, sixty elective surgical patients, ASA physical status I or II, were divided into group A (NPO less than 10 h) and group B (NPO more than 10 h). No premedication was given. Immediately following induction and intubation, the residual gastric fluid was obtained by suction using a No. 16 Sakem samp tube and its volume and pH measured. Residual gastric fluid volumes showed no statistically significant differences between the two groups (Group A: 31.76 +/- 21.51 mL Group B: 25.93 +/- 13.51 mL; T = 1.236, T less than T 0.05 = 1.96). Values for pH between the groups were also similar (Group A: 1.65 +/- 1.12; Group B: 1.52 +/- 0.73; T = 0.53, T less than T 0.05 = 1.96). Our study suggests that a significant number of patients are at risk for aspiration of acidic gastric contents and that this risk is not lowered by additional preoperative fasting time in excess of 10 h.

Adult↗
PubMed1983

Myxedema megacolon after external neck irradiation.

Myxedema megacolon is a rare manifestation of hypothyroidism. It may respond to appropriate treatment but is sometimes irreversible, resulting in fatal complications. Two possible mechanisms to explain the colonic atony include (1) myxomatous infiltration of the submucosa with separation of the muscular fibers from the ganglia of Auerbach's plexus, and (2) severe autonomic neuropathy affecting the extrinsic nerves to the colon and the myenteric plexus. Histology from our case supports the first proposed mechanism. Urecholine challenge and manometric measure response may help predict reversibility of colonic atony. Treatment should be individualized and should include factors such as age, duration of symptoms, and other medical illness. Low-dose oral or intravenous triiodothyronine is effective. Hypothyroidism following external radiation of the neck for lymphoma is not uncommon, and the risk increases following one or more lymphangiograms. Such patients should be followed up with regular TSH estimations for at least three years.

Aged↗