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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.
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이준호,이기재,기민종,김명종,두아람,손지선 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.3
Background: For patients who have back pain or radiating pain, lumbar intervention should be performed at the correct lumbar segment that triggers pain. It is quite common for pain physicians to identify lumbar segments based upon the 12th pair of ribs to do an interventional procedure. Case: We experienced two cases of rib number abnormality (absent 12th rib pair) that made the injection ineffective. In both cases, we had misidentified the lumbar segmentation due to rib abnormality. Although the procedure was performed properly, the clinical symptoms of the patient were not well correlated with the dermatome, and the diagnosis was delayed. Conclusions: These cases suggest that rib counting is necessary for more accurate lumbar segmentation. If the expected effect has not appeared after intervention, rib numbers should be checked.
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The change of stroke volume variation during thoracotomy or one lung ventilation
임형선,김동찬,김명종,유선우,기민종,강세린,김덕규 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.3
Background: Stroke volume variation (SVV) is based on cyclic changes of intrathoracic pressure during respiratory cycle. Thoracotomy and one-lung ventilation (OLV) can lead to changes in airway and intrathoracic pressure. The aim of this study was to determine whether thoracotomy and converting from two lung ventilation to OLV could affect SVV values. Methods: Thirty patients who were scheduled for pulmonary lobectomy or pneumonectomy requiring OLV were enrolled. Induction and maintenance of anesthesia were performed with propofol and remifentanil via total intravenous anesthesia. Hemodynamic variables including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and SVV were measured at intervals of 1 min for 10 min after thoracotomy and OLV, respectively. Results: MAP and HR increased from baseline at intervals between 3 and 10 min and between 4 and 10 min after thoracotomy, respectively (P < 0.001). CI increased between 4 and 10 min (P < 0.001). SVV did not change for 10 min after thoracotomy. After OLV, MAP decreased between 4 and 10 min (P = 0.112). SVV was the highest at 1 min after OLV. It returned to the baseline value at 7 min (P < 0.001). CI decreased between 8 and 10 min after OLV (P < 0.001). Conclusions: SVV can increase after OLV temporarily. Transient increase of SVV may be considered when fluid responsiveness is predicted by SVV during early period after OLV.
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