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—those that are more likely to be encountered either as an intentionally unrepaired defect or a previously undetected one. SHUNT DYNAMICS The direction of any shunt (a passage that allows movement of fluid from one part of the body to another) requires that a gradient be formed between the 2 sides of the defect. Either a pushing force or a pulling force can generate this gradient. In other terms, a gradient can be established by squeezing on a given chamber, X, into chamber Y. Conversely, if chamber Y acts as a vacuum, the direction of the

both upper extremities and the left lower extremity were compromised as a result of formation of internal shunts secondary to vascular prosthesis replacement for plasma exchange therapy and steroid pulse therapy. Her arms and legs appeared edematous. Other medical history included gastroesophageal reflux and history of hypotension. The gastroesophageal reflux was treated with sulpiride (a dopamine antagonist antipsychotic), lansoprazole (a proton pump inhibitor), mosapride citrate (a 5-HT 4 gastroprokinetic), and polaprezinc (a mucosal protective agent), and

Scaling, 153 Sedation, 74, 100, 168 Short neck length, 66 Shunt, 125 Third molar, 57 Topical anesthetic, 46 Trigeminy, 110 Vasovagal syncope, 159 Ventricular septal defect, 125 Williams syndrome, 22

aorta, pulmonary valve stenosis, and right ventricular hypertrophy. When providing anesthesia for patients with TOF, attention should be paid to prevent anoxic episodes or “tet spells,” maintain ideal hemodynamics to prevent shunting, and prevent infectious endocarditis. Additionally, the patient reported taking carteolol hydrochloride to maintain his stable cardiac status. A cardiologist was consulted regarding assessment of the patient's cardiac condition prior to the operation. ECG showed right ventricular hypertrophy, and echocardiography revealed right

uncooperative for preanesthetic evaluation. Palatoplasty under general anesthesia was scheduled for primary closure of the cleft palate. Preoperative echocardiography revealed a small ASD (12.7 × 4.7 mm) with left to right shunt and PS (pressure gradient, 24 mm Hg). Ejection fraction was 67%. A 12-lead electrocardiogram (ECG) revealed sinus rhythm. Electrolytes were within normal limits. No abnormal findings were observed on chest X-ray. On admission, his heart rate (HR) was 123 bpm, blood pressure (BP) was 105/70 mm Hg, and oxygen saturation by pulse oximetry

catalyzes the first step in the pentose phosphate pathway ( Figure 1 ). The pentose phosphate pathway (PPP) includes converting glucose to ribose-5-phosphate, a precursor to RNA, DNA, ATP, CoA, NAD, and FAD. The pathway also includes the creation of NADPH, which provides the reducing energy of the cell by maintaining the reduced glutathione within the cell. Reduced glutathione functions as an antioxidant and protects cells against oxidative damage. 2 Figure 1 The hexose monophosphate shunt. Figure 1. The hexose

patient was extubated. After returning to baseline, the patient was answering questions, following commands, and displayed intact anterograde memory. The patient required surgery to remove clots and revascularize the dialysis shunt in her left forearm due to stagnant blood flow during the cardiac episode. One week postarrest, her ejection fraction had rebounded to 46%, and she displayed no physical or neurological impairment. She was released from the hospital 8 days following the event. Her discharge diagnosis was respiratory failure and cardiac arrest secondary to

inadequate oxygen delivery to all body tissues, COPD produces a significant strain on the right ventricle of the heart. Impaired delivery of oxygen to the alveoli causes constriction of pulmonary vessels. This reflex is believed to be an effort on the part of the body to shunt blood toward better oxygenated alveoli for gas exchange. However, this resistance within the pulmonary arteries overburdens the right ventricle in attempting to pump blood through the lungs. In severe cases, the right ventricle may fail as a result of this strain—a condition called cor pulmonale. In