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요추 전 후방 유합술을 받는 환자에서 마취 중 발생한 심장성 쇼크: 증례보고
안현준 ( Hyeon Jun An ),정준영 ( Jun Young Chung ) 경희대학교 경희의료원 2020 慶熙醫學 Vol.35 No.1
When spinal procedures are performed in prone position, pressure is necessarily exerted in the thoracic and abdominal regions. Such pressure induces obstruction of the inferior vena cava which in turn causes venous pooling, resulting in increased blood loss. Hence, many devices have been developed and are currently used to relieve pressure. Among them, a bolster is a device used to cushion the thoracic and abdominal regions, relieving pressure between the two bolsters thus preserving venous return, decreasing venous engorgement and minimizing blood loss. However, the surface area of contact between such devices and the patient is small, causing focal pressure points. Of note, patient malposition can cause severe thoracic wall compression and may even incite cardiogenic shock and must be closely monitored when changing the patient’s position during surgery. In this case, the authors experienced an incidence of cardiogenic shock in a patient receiving anterior posterior lumbar fusion using only abdominal and thoracic bolsters and presents the case along with a review of current literature.
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