Association between Depression and Mortality in Patients with Pain Conditions: A South Korean Nationwide Cohort Study

송인애,오탁규,박혜윤 연세대학교의과대학 2023 Yonsei medical journal Vol.64 No.8

Purpose: Patients with pain conditions may experience depression that greatly complicates treatment. In this study, we exam ined risk factors for depression in patients with pain conditions and associations between depression and long-term mortality in such patients. Materials and Methods: Data from the National Health Insurance Service database in South Korea were used in this cohort study. A total of 2.5% of adult patients diagnosed with pain conditions in 2010 were selected using a stratified random sampling tech nique and included for analysis. We performed multivariate logistic regression modelling to identify risk factors associated with depression and multivariate Cox regression modelling to determine whether depression is associated with 10-year survival out comes in patients with pain conditions. Results: In total, data from 1808043 patients with pain conditions in 2010 were analyzed. Among them, 70148 (3.9%) patients had depression. Multivariate logistic regression modelling identified older age, comorbidities, analgesics, female sex, living in an ur ban area, and other underlying psychiatric morbidities as potential risk factors for depression in patients with pain conditions. Multivariate Cox regression revealed that 10-year all-cause mortality in patients with depression was 1.13-fold (hazard ratio, 1.13; 95% confidence interval, 1.11–1.16; p<0.001) higher than that in patients without depression and pain conditions. Conclusion: We identified a few potential risk factors for depression among South Korean patients with pain conditions. Depres sion was associated with elevated 10-year all-cause mortality in patients with pain conditions.

폐암 환자의 폐엽 절제 후 발생한 악성 허혈성 뇌졸중

송인애,정상민,김동진,박상헌 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.3

Malignant cerebral infarction as postoperative complication after pulmonary resection occurs rarely, but can be rather serious. We report a case of 81-year-old man who suffered from malignant cerebral infarctions after pulmonary resection for lung cancer. He had a history of well-controlled hypertensions, but no evidences of arrhythmia, and neither stenosis nor atheroma in the carotid arteries and intracranial arteries. There were no specific events during his operation except that an inadvertent left carotid artery puncture occurred during the central line insertion. In intensive care unit (ICU), he had a delayed recovery of consciousness and dysarthria with right hemiplegia. Computed tomography revealed malignant middle cerebral infarctions due to the occlusion of left middle cerebral artery. It could be the thromboembolism due to pulmonary resections or carotid artery punctures in the patient without high risk factors.

제왕절개술을 위한 척추마취에서 신체 측정 계수가 저혈압 발생과 ephedrine 사용량에 미치는 영향: 신장, 체중, 체질량지수, 복부둘레의 비교

송인애,신우경,현선지,박성주,유정희,전영태,황정원,도상환 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.4

Background: Hypotension is a common complication of spinal anesthesia for cesarean delivery. The incidence and severity of hypotension is reported higher compared with other surgeries due to aortocaval compression. We evaluated whether body weight,body height, body mass index (BMI) and abdominal circumference effected on the incidence of hypotension and ephedrine requirement. Methods: A total of 55 parturients undergoing elective cesarean delivery were enrolled in this prospective observational study. Preeclampsia or eclampsia was excluded. Abdominal circumference,body weight, body height were assessed before anesthesia. Spinal anesthesia was conducted in the right lateral position using 8 mg of 0.5% hyperbaric bupivacaine and 15 μg of fentanyl. Blood pressure was measured before anesthesia and at 1 min interval after intrathecal injection. Nausea was assessed during spinal anesthesia. Hypotension was defined that blood pressure decreased below 80% of baseline value and ephedrine was given if blood pressure dropped below 70% (severe hypotension). Results: The total incidence of hypotension was 65% (36/55) and ephedrine was administered in 38% (21/55) of parturients. Except height, abdominal circumference, body weight and body mass index were associated with the incidence of hypotension (P < 0.05). However, severe hypotension requiring ephedrine (P = 0.001, OR = 1.16, [95% CI 1.04−1.30]), ephedrine requirement (P = 0.001,R = 0.43) and nausea (P = 0.026, R = 0.31) were significantly related only with abdominal circumference. Conclusions: Abdominal circumference of parturients may be a good parameter to predict both of the incidence and the severity of hypotension during spinal anesthesia for cesarean delivery.

지체․뇌병변 장애인의 평생교육 참여경험에 관한 현상학적 연구

송인애(Song, In Ae),오민석(O, Min-Suk) 학습자중심교과교육학회 2019 학습자중심교과교육연구 Vol.19 No.20

본 연구의 목적은 지체ㆍ뇌병변 장애인의 평생교육 참여경험과 본질적 의미를 탐색해보는 것이다. 연구방법으로는 Giorgi(1997)의 현상학적 방법을 사용하여 지체ㆍ뇌병변 장애인 5명을 대상으로 2019년 3월부터 6월까지 참여적 관찰과 심층 면담, 전화, 내러티브 기술지 등 다양한 질적 자료를 수집, 분석하였다. 연구결과 지체ㆍ뇌병변 장애인들의 평생교육 참여경험은 다음의 세 가지 국면을 띄고 있었다. 첫째, 배움을 통한 폭넓은 관계와 자존감 향상은, 자립으로 이어져 ‘내가 잘 살고 있구나“라 는 의미 있는 삶을 경험하였다. 둘째, 평생학습 참여에서 장애인에 대한 인식 부재,복지의 사각지대, 그리고 장애인에 대한 선 이해가 부족하여 불편함을 경험하였다. 이러한 경험 과정을 통해 장애인에 대한 인식개선 및 복지개선 그리고 장애인에 대한 이해가 선행되어야 함을 인식하는 계기가 마련되었다. 셋째, 지체ㆍ뇌병변 장애인의 평생교육 참여경험에서 드러난 본질적 의미는 삶의 질 향상이며, 제공기관 확 대와 프로그램의 다양성, 그리고 편의시설 제공 등을 통해 당사자의 욕구가 반영된 평생교육 참여를 기대하는 것으로 나타났다. 결국, 평생교육 참여는 그저 단순하게 지체ㆍ뇌병변 장애인에게 학습경험의 기회제공뿐만 아니라, 스스로 자신을 성장하 게 하고, 확장된 관계 형성 속에서 연대감을 느끼며 의미 있는 삶의 경험을 제공하였다. 나아가 이러한 긍정적인 경험은 또 다른 나눔으로 다른 장애인을 성장시키는 경험으로 이어졌으며, 장애인에 대한 인식개선과 복지개선, 그리고 장애와 장애인에 대한 올바른 이해와 함께 장애인과 비장애인이 함께 배우고 살아가는 공생사회를 기대한다. The purpose of this study is to find out the life-long education experience and essential meaning of people with disabilities such as physical disorder or brain lesion. As a method of research, various qualitative data such as participatory observations, in-depth interviews, telephone calls, and narrative writings were collected and analyzed using Giorgi (1997) s phenomenological method. Research has shown that the lifetime education experience of people with physical disorder or brain lesions had three aspects. First, extensive relationships and improved self-esteem through learning led to self-reliance and experienced a meaningful life of I m doing well. Second, the lack of awareness of the disabled, blind spot of welfare, and lack of prior understanding of the disabled in participation in lifelong learning has experienced discomfort. Through this experience process, it was necessary to recognize that awareness of the disabled, welfare improvement, and understanding of the disabled should precede. Third, it has been shown that the essential meaning shown in the experience of lifelong education by people with disabilities such as physical disorder or brain lesion is to improve the quality of life, and to expect participation in lifelong education that reflects the needs of the parties through the expansion of the provision institutions, diversity of programs and provision of amenities. Eventually, lifelong education participation not only provided opportunities for learning experiences to the disabled, but also made oneself grow up and provided a meaningful life experience, feeling a sense of solidarity in the formation of an expanded relationship. Furthermore, this positive experience has led to another experience of raising the disabled with sharing, and it has been shown to expect a symbiotic society in which disabled and non-disabled people learn and live together in the future through better awareness of the disabled, better welfare and a correct understanding of the disabled and disabled.

증례보고 : 발견되지 않은 갈색세포종이 동반된 갑상선수질암 환자의 정맥마취 유도시 발생한 빈맥과 저혈압

송인애 ( In Ae Song ),정해정 ( Hae Jung Jung ),조대순 ( Dae Soon Cho ),윤정연 ( Jung Yeon Yun ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2

A 35 year old woman with hypercalcitoninemia was scheduled for an operation to treat her medullary thyroid cancer (MTC). TIVA with propofol and remifentanil was planned, and about 3 minutes after the infusion of anesthetics, her heart rate was suddenly elevated to 180/min and the systolic blood pressure was lowered to nearly 50 mmHg. The blood pressure returned to normal after the injection of phenylephrine 100 μg and a rapid infusion of 700 ml crystalloid solution. After the operation, bilateral pheochromocytoma and a RET proto-oncogene mutation related with multiple endocrine neoplasia 2A (MEN-2A) were found. Patients with MTC can present with peripheral vasodilation and relative hypovolemia that are related with hypercalcitoninemia. Patients with MEN-2A can be anesthetized for a MTC operation without the appropriate preparation for their pheochromocytoma. Therefore, we suggest that patients with MTC and hypercalcitoninemia should be cautiously anesthetized with TIVA. They also should be screened for pheochromocytoma and the RET proto-oncogene mutation to prevent deleterious hemodynamic events during anesthesia. (Korean J Anesthesiol 2009;57:254∼8)

Cardiopulmonary resuscitation with assisted extracorporeal life support during cardiac arrest caused by drug-eluting stent thrombosis -a case report-

이주현,송인애,박상헌 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.5

Discontinuation of dual antiplatelet therapy within 12 months after drug-eluting stent (DES) implantation increases the possibility of stent thrombosis. We now report the case of a 66-year-old man who suffered a cardiac arrest due to stent thrombosis after an elective laparoscopic anterior resection. Ten month ago, he underwent DES implantation and then had been taking dual antiplatelet therapy. Nine days prior to the surgery, he discontinued dual antiplatelet therapy. Forty minutes after intensive care unit admission, cardiac arrest occurred. However, his cardiac rhythm did not restore in spite of resuscitation, so immediately veno-arterial extracorporeal membrane oxygenation (ECMO) was implanted. Four days after the surgery, he was weaned from ECMO support, recovered completely, with no cardiopulmonary or neurological sequelae.

Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery -a case report-

이재우,송인애,유정희,전영태,황정원,박희평 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.4

Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.

Trends in Mortality, Treatment, and Costs of Management of Acute Respiratory Distress Syndrome in South Korea: Analysis of Data between 2010 and 2019

오탁규,송인애 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.5

Purpose: Despite recent advances in the understanding and management of acute respiratory distress syndrome (ARDS), trendsin treatment, mortality, and healthcare costs following these advancements remain to be identified. In the present study, weaimed to investigate these trends using real-world data from a national cohort database in South Korea. Materials and Methods: Using the National Health Insurance Service database, we collected and analyzed data for critically illadult patients with ARDS who were admitted to intensive care units in South Korea between 2010 and 2019. Results: The final analysis included 25431 patients with ARDS. The 30-, 90-, and 365-day mortality rates in 2010 were 43.8%,56.5%, and 68.2%, respectively. These rates had gradually decreased to 36.6%, 50.2%, and 58.8%, respectively, by 2019. Extracorporealmembrane oxygenation support for patients with ARDS started in 2014 at a rate of 5.1% (118/2309), which gradually increasedto 8.3% (213/2568) by 2019. The rate of neuromuscular blockade treatment gradually increased from 22.6% (626/2771) in 2010 to30.9% (793/2568) in 2019. The renal replacement therapy rate gradually increased from 5.7% (157/2771) in 2010 to 12.0% (307/2568)in 2019. The mean total cost of hospitalization increased from 5986.7 USD in 2010 to 12336.4 USD in 2019. Conclusion: Real-world data for 2010–2019 indicate that patients with ARDS in South Korea have experienced changes in mortality,treatment, and healthcare costs. Despite the increased financial burden, mortality among patients with ARDS has decreaseddue to advances in disease management.

수술 후 serotonin 대사물(5-HIAA)의 혈중농도 변화와 serotonin 수용체 유전자형이 수술 후 구역 및 구토에 미치는 영향

길남수,송인애,나효석,이정민,박희평,전영태,황정원,도상환 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.1

Background:Post-operative nausea and vomiting (PONV) is a common problem in the patients undergoing laparoscopic surgery. The release of serotonin during surgical procedure may induce PONV. We investigated if postoperative increase in plasma serotonin metabolite and genotype of serotonin receptor were associated with PONV after gynecologic laparoscopic surgery. Methods:The patients who experienced nausea after gynecologic laparoscopic surgery (PONV group, n = 20) and who had no or mild nausea (control group, n = 20) were enrolled. Median value of nausea (100 mm visual analogue scale, VAS) was 0 (0−20) in control group and 60 (40−100) in PONV group (P < 0.001). Postoperative nausea was assessed during 1 hr in post-anesthetic care unit. Blood samples were obtained before anesthesia and 1 hr after surgery. Plasma serotonin metabolite (5-hydroxy indole acetic acid, 5-HIAA) was analyzed using high performance liquid chromatography (HPLC) assay. Perioperative change of plasma 5-HIAA and Pro16Ser genotypes were compared between groups. Results:Average 5-HIAA concentration of all patients increased after surgery (3.65 ± 0.90 to 4.36 ± 1.17 ng/ml, P < 0.001).Baseline plasma 5-HIAA concentrations were similar between groups, but, 5-HIAA of PONV group increased higher after laparoscopic surgery compared with control group (3.69 ± 0.89 to 4.62 ± 1.12 ng/ml vs. 3.61 ± 0.93 to 4.10 ± 1.20 ng/ml, P = 0.03). Pro16Ser genotypes were not different between groups Conclusions:The patients who experienced post-operative nausea showed more increase in 5-HIAA concentration. PONV after gynecologic laparoscopic surgery may be associated with a peripheral release of serotonin.(Anesth Pain Med 2011; 6: 37∼40)

Should Very Old Patients Be Admitted to the Intensive Care Units?

차준권,송인애 대한중환자의학회 2017 Acute and Critical Care Vol.32 No.4