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증례보고 : Child-Pugh Class B 간경변 환자의 대동맥 판막 치환술, 삼첨판 성형술과 심실 중격 결손 봉합의 마취 경험
안여현 ( Yeo Hyun Ahn ),김지연 ( Ji Yeun Kim ),이상일 ( Sang Il Lee ),김경태 ( Kyung Tae Kim ),최원주 ( Won Joo Choe ),박장수 ( Jang Su Park ),김정원 ( Jung Won Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Open heart surgery under cardiopulmonary bypass (CPB) in patients with liver cirrhosis is prone to the development of various complications associated with high mortality rates. According to recent studies, patients with advanced cirrhosis (Child-Pugh class B or C cirrhosis) have a significantly higher mortality rate (50-100%) after open heart surgery under CPB. We report the anesthetic management of cardiac surgery using CPB of 61-year-old man with aortic valve regurgitation, tricuspid regurgitation and ventricular septal defect (VSD) who had complicated by liver cirrhosis of Child-Pugh class B. The patient underwent successfully aortic valve replacement, tricuspid valvuloplasty and VSD closure. The use of tranexamic acid and transfusion of fresh whole blood appears to produce beneficial effects for outcome. (Korean J Anesthesiol 2009;56:578~82)
역행성 심정지 도관 삽입을 위한 술 중 경식도심초음파의 유용성
유미숙;최원주;김정원;박장수;김경태;김지연;어상일 인제대학교 2011 仁濟醫學 Vol.32 No.-
Background: Retrograde cardioplegia catheter (RCC) insertion is one of methods for administration of cardioplegics during cardiopulmonary bypass (CPB). However its success rate depends on only surgeon's experience. We thought the transesophageal echocardiography (TEE) can guide the R CC insertion, because TEE is commonly used for monitoring status of heart during cardiac surgery. This study was designed to evaluate the RC C insertion time by TEE guidance versus conventional method without T EE guidance. Methods: Sixty patients who were scheduled to undergo elective coronary artery bypass graft (CABG) surgery under general anesthesia were divided into groups as follows: group T [RCC insertion into coronary sinus (CS) by TEE guidance, n=30] and group C [RCC insertion into CS by conventional method, n=30]. We recorded the time of insertion of RCC in to CS in two groups. RCC insertion was done by TEE guidance in case that time was over two minutes by conventional methods in group C. Results: The overall time of RCC insertion into CS was 63.8 ± 23.6 seconds in the Group T and 102.3 ±55.7 seconds in the Group C, respectively (p=0.001). There were no complications during RCC into CS by T EE guidance. Conclusions: TEE guidance for RCC insertion into CS is shorten the time of insertion.
Midazolam을 이용한 술중 자가진정조절과 마취의에 의한 진정조절의 비교
이승준,윤영준,길호영,최원주 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.1
Background : Because of wide individual variations in response to sedative and the level of sedation desired by different patients, inadequate sedation is frequent during surgery. Patient-controlled sedation is a logical extension of patient-controlled analgesia to find and maintain their own steady-state of sedation by self-administration of sedatives during surgery. The purpose of this study was to evaluate the feasibility of patient-controlled sedation compared with anesthesiologist-controlled sedation during surgical spinal anesthesia. Methods : Unpremedicated forty adult patients who received spinal anesthesia for lower extremity surgery were randomly allocated into two groups(n=20 for each group). After selection of target state of sedation according to sedation scale, patient-controlled sedation(PCS) group self-administered 0.5 mg(1 ml) intravenous midazolam in increments using a Walkmed PCA infusor and anesthesiologist- controlled sedation(ACS) group administered by the anesthesiologist as the same manner to achieve previously selected sedation state. Sedation score, vital signs, SpO2 were checked 5, 10, 20, 30, 40min after start of drug injection. Results : The sedation scores patient desired were 4.4±0.8 in PCS group and 4.3±0.7 in ACS group. These scores were achieved 20min after start of injection in PCS group and 40 min in ACS grou p(p$lt;0.05). Degree of satisfaction was higher in PCS group compared with ACS group(1.5±0.6 vs 2.1±0.8, p$lt;0.05). No complications were detected in two groups. Conclusions : PCS using midazolam was better than ACS in terms of early achievement of sedation state patient desired and degree of satisfaction. (Korean J Anesthesiol 1997; 33: 54∼58)