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임상연구 : 간우엽 공여술 후 혈액응고 상태의 변화와 경막외 카테터 사용 시의 의미
최수주 ( Soo Joo Choi ),곽미숙 ( Mi Sook Gwak ),김갑수 ( Gaab Soo Kim ),이준용 ( Jun Yong Lee ),김태형 ( Tae Hyeong Kim ),김진경 ( Jin Kyung Kim ),김정수 ( Chung Soo Kim ),정익수 ( Ik Soo Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: Living donors for liver transplantations may have a low pain threshold and should be given effective postoperative pain control. However, epidural catheterization has been the subject of intense debate because of the possibility of severe coagulation derangement after a right hepatectomy. This study examined the changes in the coagulation status in right lobe donors. Methods: The charts and computerized hospital data of 261 consecutive living donors who had undergone right hepatectomy were retrospectively reviewed. The coagulation profile including the platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) was analyzed at the preoperative period, immediately after surgery, and 5 days after surgery. Results: The platelet count decreased significantly from immediately after surgery until postoperative day (POD) 5 (P < 0.001). Nineteen donors (7.3%) had a minimum platelet count of < 100 × 103/mm3, and no case showed a platelet count of < 50 × 103/mm3. The PT increased significantly and reached at peak at POD 1 (1.56 ± 0.19 INR), and the PT values until POD 5 were significantly different from the preoperative values (P < 0.001). However, the peak PT was > 2.0 INR in only 4 donors (1.5%). The aPTT immediately after surgery showed severe prolongation (P < 0.001), but recovered rapidly on POD 1. Conclusions: Right lobe donors showed postoperative coagulation derangement but the changes appear to be acceptable for the maintenance and removal of the epidural catheters. These results suggest that careful epidural catheterizations are relatively safe in right lobe donors. (Korean J Anesthesiol 2006; 51: 685~9)
증례보고 : 소장 절제술을 시행받은 환아에서의 소장 이식 수술의 마취 관리
김한수 ( Han Soo Kim ),김형균 ( Hyung Kyun Kim ),김지애 ( Jie Ae Kim ),방시라 ( Si Ra Bang ),김갑수 ( Gaab Soo Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Small bowel transplantation is becoming the treatment of choice for short-gut syndrome. Improvements in surgical techniques, immunosuppressants, and anesthetic management of patients have allowed this procedure to become the standard of treatment for patients who are unable to continue total parenteral nutrition (TPN) therapy due to TPN-associated complications. We experienced small bowel transplantation in a 10-month-old male infant who had small bowel resection for small bowel volvulus and has suffered from complications such as recurrent sepsis, disseminated intravascular coagulation (DIC) due to long-term TPN. We report our experience with a brief review of the relevant literature. (Korean J Anesthesiol 2007; 53: 791∼5)
임상연구 : 주술기에 발생하는 압력에 의한 피부 손상의 발생률과 위험 인자의 조사
최수주 ( Soo Joo Choi ),김대원 ( Dae Won Kim ),정혜선 ( Hye Seon Chung ),안현주 ( Hyun Joo Ahn ),곽미숙 ( Mi Sook Gwak ),양미경 ( Mi Kyung Yang ),이상민 ( Sang Min Lee ),김갑수 ( Gaab Soo Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Pressure-induced skin breakdown is not only a painful inconvenience to the patient, but it is also associated with a prolonged hospital stay. This study examined the incidence of pressure-induced skin breakdown in attempt to identify the associated risk factors during elective surgery. Methods: Data were collected from 808 subjects who underwent orthopedic, thoracic, neuro- or plastic surgery over a six-month period. The data included age, gender, weight, height, body mass index, ASA status, surgical position, operation time, estimated blood loss, preoperative hemoglobin concentration, serum albumin, co-morbidity, and intraoperative hypotension. The patient`s skin was inspected closely within 24 hours after surgery. The sites and severity of skin breakdown were assessed. Results: Of the 808 patients in this study, 192 patients (23.8%) developed skin breakdown during surgery. The incidence of blisters, abrasion, or blister and abrasion was 6.1%. The patient`s weight, operation time, estimated blood loss, malignancy, and intraoperative hypotension were significantly related to the development of skin breakdown (P < 0.05). The incidence of pressure-induced skin breakdown was highest in the prone position (P = 0.000). Age, gender, body mass index, hypertension, diabetes, preoperative hemoglobin and albumin level were not found to be risk factors of skin breakdown. Conclusions: The early identification of a patient at risk is a first step in a scientifically based approach for preventing the development of pressure sores. Although intervention will not always prevent the development of pressure sores, a medical team must recognize the risk factors associated with skin breakdown and carry out careful intervention during the perioperative period. (Korean J Anesthesiol 2006; 50: 525~9)