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임상연구 : 전신마취를 받는 환자에서 발생하는 압박 욕창의 발생률과 위험인자의 조사
황희윤 ( Hee Youn Hwang ),신용섭 ( Yong Sup Shin ),조현성 ( Hyun Sung Cho ),여진석 ( Jin Seok Yeo ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
Background: The occurrences of pressure sores have an extensive impact on patients and the medical team. Pressure sores decrease quality of life and productivity, as well as increase the overall cost of treatment. The purpose of this study was to identify the risk factors associated with pressure ulcers among surgical patients. Methods: Data were collected from 588 patients who underwent general anesthesia. The data included age, gender, weight, height, body mass index, ASA status, surgical position, anesthesia time, pre-and postoperative hemoglobin concentration, serum albumin, NYHA class, co-morbidity, steroid use, body temperature, use of warming water mattress and preoperative hospital admission day. The patient`s skin was inspected closely before surgery and again within 24 hours after surgery and the locations and severity of skin breakdowns were assessed. Results: Twenty-five patients (4.3%) developed pressure sores during surgery. The hemoglobin concentration change between the preoperative and postoperative period (≥2 g/dl), position during surgery, length of stay before operation (≥4 days), anesthesia time (≥5 hours) and decrease in body temperature (≥0.5℃) were significantly related to the development of pressure sores (P < 0.05). Conclusions: Five risk factors for pressure ulcers were confirmed. The anesthesiologist can decrease hemoglobin and modify body temperature; therefore, attention should be given to these risk factors during the operation. (Korean J Anesthesiol 2007; 53: 79~84)
임상연구 : 두부 하강, 외회전 자세에서의 내경정맥과 경동맥의 관찰
정익수 ( Ik Soo Chung ),권민아 ( Min A Kwon ),황희윤 ( Hee Youn Hwang ),박정헌 ( Jeong Heon Park ),여진석 ( Jin Seok Yeo ),김정수 ( Chung Su Kim ),함태수 ( Tae Soo Hahm ),이상민 ( Sang Min Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: This study evaluated the position and relationship between the right internal jugular vein (IJV) and the surrounding external landmarks using ultrasonography. Methods: Fifty-four patients undergoing central vein access for cardiac surgery were enrolled in this study. The IJV, carotid artery (CA) and sternocleidomastoid muscle (SCM) at the cricoid cartilage level in 15˚ trendelenburg position with 30˚ head rotation were examined using a two dimensional ultrasound transducer of a TEE machine. Images of the vessels and the demographic data of the patients were recorded and analysed. Results: At the level of the cricoid cartilage, the position of the right IJV was medial to middle of the clavicular head of the SCM muscle in 26 cases (48.2%), lateral in 11 cases (20.4%) and just above the middle of clavicular head of the SCM muscle in 17 cases (31.5%). In 43 patients (79.6%), the IJV overlapped the CA anterolaterlly < 5 mm, and these cases were regarded as normal. Ten patients (18.5%) had a medially positioned IJV overlapping the CA more than 5 mm and the IJV was positioned lateral to CA in 1 (2%) patient. The mean ratio of the overlapped diameter and the diameter of the CA was 33.6% and the overlapping ratios were greater than 50% in 10 patients (31.4%). The mean skin-to-vein distance at the angle of 30˚ was 1.82 cm. Conclusions: In 18.5% of patients positioned in the 15˚ Trendelenburg position, with their head turned to the left 30˚, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique. (Korean J Anesthesiol 2006; 51: 11~6)
임상연구 : 마취 중 H1-수용체 길항제 투여에 의한 혈역학적 변화에 대한 고찰
함태수 ( Tae Soo Hahm ),김정수 ( Chung Soo Kim ),구명신 ( Myong Shin Koo ),신병섭 ( Byung Seop Shin ),황희윤 ( Hee Youn Hwang ),이상민 ( Sang Min Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: Antihistamine agents are one of the most common drugs used during perioperative periods. As histamine can cause various hemodynamic reactions, administration of antihistamine can also result in unexpected responses. Therefore, we investigated what kind of hemodynamic changes might occur after the administration of antihistamine. Methods: We prospectively performed this study on 12 patients who underwent lung surgery. After induction of anesthesia, Swan-Ganz catheter was introduced and continuous arterial blood pressure was checked via radial arterial catheterization. Initial hemodynamic parameters were checked. Based on these parameters, we calculated systemic vascular resistance (SVR), pulmonary vascular resistance (PVR). After administration of chlorpheniramine maleate 8 mg, hemodynamic parameters were checked and calculated at 2, 4, 6, 8, 10, 12, and 15 minute. Then, we made comparisons of these values with initial values. It is commonly recommended to maintain hemodynamic values within 20% of baseline for safe use of a drug. Results: SVR and PVR failed to show statistically significant changes. Heart rates were increased only at 2 minute after administration of chlorpheniramine maleate. Blood pressures were increased but returned to basal level within 4 minutes. Cardiac output showed statistically significant increase until 8 minutes. However, the changes of hemodynamic values were maintained within 20% of basal levels. Conclusions: Chlorpheniramine maleate is observed to cause statistically significant hemodynamic change after intravenous administration during anesthesia. But the changes were within 20% of basal levels, and we can safely use chlorpheniramine maleate 8 mg IV in the view of hemodynamic changes. (Korean J Anesthesiol 2006; 51: 395~9)
실험연구 : 잡견에서 Bupivacaine의 주입에 의한 심장 독성 발생 시 시행한 심폐소생술에서 인슐린 부가 효과의 연구
함태수 ( Tae Soo Hahm ),신병섭 ( Byung Seop Shin ),김정수 ( Chung Su Kim ),이상민 ( Sang Min Lee ),여진석 ( Jin Seok Yeo ),황희윤 ( Hee Youn Hwang ),이국현 ( Kook Hyun Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Because of the difficulty of resuscitation caused by bupivacaine-induced cardiotoxicity, the choice of resuscitation medication is still unclear. We investigated whether insulin can improve outcomes of resuscitation by epinephrine from bupivacaine-induced cardiovascular collapse. Methods: Twenty-four mongrel dogs were randomly allocated to one of the two groups: an EPI group (n = 12), and an EPI + RI group (n = 12). Sixty minutes after induction of general anesthesia, baseline measurement of hemodynamic parameters and arterial blood gas tension was performed. Bupivacaine infusion was started at a rate of 0.5 mg/kg/min and kept until mean arterial blood pressure fell below 40 mmHg and heart rate 40 beats per minute. At this point, bupivacaine infusion was stopped and resuscitation was started, with epinephrine in EPI group and epinephrine combined with regular insulin in EPI + RI group. Results: Bupivacaine infusion caused significant decreases in mean arterial blood pressure, heart rate, cardiac output, and systemic vascular resistance and increases in mean pulmonary blood pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, and central venous pressure. The recovery rate of EPI + RI group (8/12) was higher than that of EPI group (2/12). Conclusions: Combined administration of epinephrine and regular insulin improves outcomes of resuscitation of bupivacaine-induced cardiovascular collapse. Therefore, we believe that prompt administration of insulin should be strongly considered in case of bupivacaine-induced cardiotoxicity. (Korean J Anesthesiol 2006; 50: 579~84)