The prevalence and clinical significance of transitional vertebrae: a radiologic investigation using whole spine spiral three-dimensional computed tomographic images

두아람,이정우,여귀은,이근형,김예슬,문주환,한영진,손지선 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.1

Background: Errors in counting spinal segments are common during interventional procedures when there are transitional vertebrae. In this study, we investigated the prevalence of the transitional vertebrae including thoracolumbar transitional vertebra (TLTV) and lumbosacral transitional vertebrae (LSTV). The relationship between the existence of TLTV and abnormal rib count or the existence of LSTV were also evaluated. Methods: The vertebral levels were counted craniocaudally, starting from C1, based on the assumption of 7 cervical, 12 thoracic, and 5 lumbar vertebrae, using whole spine spiral three-dimensional computed tomographic images. The 20th and 25th vertebrae were defined as L1 and S1, respectively. Results: In total, 150 patients had TLTV, with a prevalence of 11.2% (150/1,340). LSTV was observed in 111 of 1,340 cases (8.3%). Sacralization was observed in 68 of 1,340 cases (5.1%) and lumbarization in 43 of 1,340 cases (3.2%). There was a significant relationship between the existence of TLTV and the abnormal rib count (odds ratio [OR]: 117.26, 95% confidence interval [95% CI]: 60.77–226.27; P < 0.001) and LSTV (OR: 7.38, 95% CI: 3.99–13.63; P < 0.001). Conclusions: Our study results suggest that patients with TLTV are more likely to have an abnormal rib count or LSTV. If a TLTV or LSTV is seen on the fluoroscopic image, a whole spine image is necessary to permit accurate numbering of the lumbar vertebra.

Comparison of prophylactic anti-emetic effects of ramosetron between single bolus administration and continuous infusion following bolus administration

두아람,오성민,김봉곤,고성훈 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.2

Background: The authors hypothesized that the continuous infusion of ramosetron 0.15 mg following a 0.15 mg bolus administration would maintain higher 5-hydroxytryptamine type 3 receptor occupancy levels and be more effective in preventing postoperative nausea and vomiting (PONV) than a 0.3 mg single bolus administration. We conducted a study to compare the efficacy of single bolus ramosetron administration with the combination of continuous infusion following intravenous bolus administration for PONV prophylaxis. Methods: One hundred and fifty female patients undergoing thyroidectomy were allocated randomly to one of three groups to receive a placebo (Group 1, n = 49), 0.3 mg of IV ramosetron (Group 2, n = 53), or the continuous infusion of 0.15 mg ramosetron following a bolus administration of 0.15 mg of ramosetron (Group 3, n = 48). Anesthesia was maintained with sevoflurane and N2O. The incidence of PONV, nausea severity, and use of rescue antiemetics during the postoperative 24 hours were recorded. Results: Group 1 showed higher incidences of PONV during the postoperative 24 hour than Group 2 (81% vs. 58%, P = 0.02) and Group 3 (81% vs. 48%, P < 0.01), but there was no difference between Groups 2 and 3 (P = 0.39). The use of rescue antiemetics was significantly lower in Groups 2 and 3 than Group 1 during the postoperative 6 to 24 hours. Conclusions: There were no significant differences of incidence and severity of PONV between ramosetron 0.3 mg single bolus administration and the combination of ramosetron infusion after 0.15 mg bolus administration.

Effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in thyroid surgery

두아람,황현섭,기민종,이준례,김동찬 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.5

Background: Although the positive effects of preoperative oral carbohydrate administration on clinical outcomes following major surgery have been reported continuously, there are few investigations of them in minor surgical patients. The present study was designed to examine the effects of preoperative oral carbohydrate administration on patient well-being and satisfaction in patients undergoing thyroidectomy. Methods: Fifty adults aged 20–65 years and scheduled for elective thyroidectomy in first schedule in the morning were allocated to one of two groups. The Control group (n = 25) was requested to obey traditional preoperative fasting after midnight prior to the day of surgery. The Carbohydrate group (n = 25) also fasted overnight but drank 400 ml of carbohydrate- rich drink 2 hours before induction of anesthesia. Patient well-being (thirst, hunger, mouth dryness, nausea and vomiting, fatigue, anxiety and sleep quality) and satisfaction were assessed just before the operating room admission (preoperative) and 6 hours following surgery (postoperative). Other secondary outcomes including oral Schirmer’s test and plasma glucose concentrations were also evaluated. Results: The two groups were homogenous in patient characteristics. Seven parameters representing patient well-being evaluated on NRS (0–10) and patient satisfaction scored on a 5-point scale were not statistically different between the two groups preoperatively and postoperatively. There were no statistically significant differences in secondary outcomes. Conclusions: Preoperative oral carbohydrate administration does not appear to improve patient well-being and satisfaction compared with midnight fasting in patients undergoing thyroidectomy in first schedule in the morning.

Anesthetic management of a pregnant woman undergoing laparoscopic surgery for pheochromocytoma -A case report-

두아람,한영진,김덕규,차경남,김동찬 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.4

Pheochromocytoma is a rare catecholamine producing tumor. Anesthetic management for the resection of pheochromocytoma is hard and challenging issue to anesthesiologist, because of its potentially lethal cardiovascular complications. It becomes more complicated when the patient is pregnant. Clinicians must keep the safety of both mother and fetus in mind. The timing of surgery for pheochromocytoma in pregnancy is very important for the maternal and fetal safety and depends on the gestational age when diagnosis is made, clinical response to medical treatment, the surgical accessibility of the tumor, and the presence of fetal distress. We report anesthetic experience of a laparoscopic resection for pheochromocytoma in 25th week gestational woman.

The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery

두아람,강세린,김예솔,이태원,이준래,김동찬 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.1

Background: Although the quality of postoperative recovery may be affected by factors, there are few investigations whether the type of anesthesia also affects it. In this single-blinded, prospective, observational study, we compared the quality of postoperative recovery in patients undergoing orthopedic forearm surgery under general or regional anesthesia (brachial plexus block). Methods: Ninety-seven subjects, aged 18–65 years and American Society of Anesthesiologists physical status I or II, undergoing orthopedic forearm surgery, were allocated to general or regional anesthesia group. The quality of postoperative recovery was assessed using a validated Korean version of Quality of Recovery-40 (QoR-40K) questionnaire. Patients were surveyed three times, the day before surgery (baseline) and 1st and 7th day after the surgery, and the scores of both groups were compared. Results: We analyzed 47 and 50 patients in general and regional anesthesia, respectively. The global QoR-40K score and those of each of its five dimensions were not significantly different between the two groups at baseline, 1st and 7th day postoperatively. In two-way RM ANOVA, the global QoR-40K score at postoperative 1st day was significantly lower than that of baseline (P < 0.001) and postoperative 7th day (P < 0.001), respectively, in both general and regional anesthesia groups. However, there was no significant difference at each timepoint between the two groups. Conclusions: The present study suggests that brachial plexus block with intravenous dexmedetomidine infusion does not improve the quality of postoperative recovery compared to sevoflurane inhalation anesthesia with remifentanil infusion in patients undergoing orthopedic forearm surgery.

급성 신부전 환자에서 지속적 신대체요법을 이용한 마취관리 -증례 보고-

두아람 ( A Ram Doo ),장은주 ( Eun Joo Jang ),김덕규 ( Deok Kyu Kim ) 전북대학교 의과학연구소 2014 全北醫大論文集 Vol.38 No.2

The treatments for acute renal failure include recovery of renal perfusion, correction of reversible cause, normalization of plasma electrolytes and renal replacement therapy. Continuous renal replacement therapy (CRRT) is preferred to intermittent hemodialysis due to its superior hemodynamic stability with resultant effective elimination of water and toxins in critical care fields. We report a case of successful anesthetic management using CRRT in patient receiving emergent small bowel resection with acute renal failure complicated by sepsis.

미추 경막외 주사에 의해 발생한 척수 경막하 혈종으로 오인된 자발성 두개내압 저하증 -증례 보고-

두아람 ( A Ram Doo ),김봉곤 ( Bong Gon Kim ),김동찬 ( Dong Chan Kim ) 전북대학교 의과학연구소 2015 全北醫大論文集 Vol.39 No.1

자발성 두개내압 저하증은 뇌척수막의 구조적 위약으로 인한 뇌척수액의 누출로 인하여 발생한다. 자발성 두개내압 저하증의 진단에 있어서 뇌 자기공명영상 소견이 필수적이라고 할 수 있지만, 척추 내 수액 고임, 경막의 조영 증강, 경막외 혈관 확장 등의 특징적인 척추의 영상학적 소견이 관찰될 수도 있다. 저자는 최근의 급성 뇌경색으로 3일간의 항응고요법 후 항혈소판제제를 복용중이었던 환자에서 요통으로 미추 주사를 시행한 후 발생한 경막하 혈종으로 오인된 자발성 두개내압 저하증의 증례를 소개하고자 한다. Spontaneous intracranial hypotension(SIH) is manifested by spinal cerebrospinal fluid leakage due to the structural weakness of the spinal meninges. Although brain MRI is essential to the diagnosis of SIH, characteristic imaging findings of the spine such as spinal fluid collection, dural enhancement, and epidural venous enlargement may be detected. We report a rare case of spontaneous intracranial hypotension misunderstood as spinal hematoma complicated by prior caudal block during antiplatelet medication followed by anticoagulation for 3 days for acute cerebral infarction.

Let’s Take Advantage of Mixtures of Bupivacaine or Ropivacaine in Urologic Inguinal and Scrotal Surgery

신유섭,두아람,박종관 대한남성과학회 2018 The World Journal of Men's Health Vol.36 No.2

Respiration apparatus comprising fixing string: a new design of double (head and neck) straps for patient face mask

이상귀,두아람 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.6

그리셀증후군 환자에서 I-gel 성문상기도유지기를 사용한 기도관리 -증례보고-

이철형,두아람,우철종,손지선,이상귀,김연동,Lee, Cheolhyeong,Doo, A Ram,Woo, Cheol Jong,Son, Ji-Seon,Lee, Sang-Kyi,Kim, Yeon-dong Korea Convergence Society 2021 한국융합학회논문지 Vol.12 No.10

그리셀 증후군은 환축관절의 비외상성 탈구로 인하여 전신마취 시 경추손상이 발생할 가능성이 있어 신중한 마취관리를 요한다. 이에 우리는 과거에 그리셀 증후군을 받은 진단받은 환자의 전신마취 하 전립선 레이저절제술 시 I-gel을 이용한 기도관리를 성공적으로 진행하였고, 환자는 신경학적 합병증 없이 잘 회복된 사례를 보고하고자 한다. 그리셀 증후군 환자의 마취 관리 시 기도관리를 위하여 I-gel을 사용하는 것이 좋은 대안이 될 수 있을 것이다. Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joint with an inflammatory condition in the adjacent soft tissues. Due to the instability of the cervical spine, careful airway management is crucial to prevent potential cervical spinal cord injury following airway manipulation. We successfully secured the patient airway using a supraglottic airway device (I-gel) in a patient who had previously diagnosed with Grisel's syndrome. The operation was successfully completed, and the patient recovered without any neurological complications. I-gel can be a good option for airway management during general anesthesia in a patient diagnosed with Grisel's syndrome.