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Operation room management in Korea: results of a survey
임춘학,장준철,임형환,배고은,최성욱 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.5
Background: The current state of general hospital operation room (OR) in Korea and how these ORs are being operated remain unclear. Therefore, the aim of this study was to investigate and assess the current state of OR management and surgical scheduling in general hospitals of Korea. Methods: A total of 92 anesthesiology training hospitals and 2 equivalent hospitals in Korea were targeted for the survey. Anesthesiologists in hospitals received questionnaires for OR, anesthetic managements and surgical scheduling directly or by phone from the beginning of October 2015 to the end of December 2015. Results: Of the 94 hospitals that were targeted, 59 hospitals (62.7%) responded to the survey. Of the 59 hospitals, 40 (67.8%) had 500–1,000 beds, 36 (61.0%) had 11–20 ORs. Most OR arrangements were made by residents and specialists in Anesthesiology Department (90%). Most hospitals (47.4%) in the response set performed total surgeries in the range of 10,000 to 20,000 annually. The proportion of emergency surgeries in the total surgeries was 2.8−55.0%. Methods for predicting expected surgery time were arbitrarily decided by surgeons (61%), anesthesiologist’s experience (20%), or by analyzing historical data using software (5%). Conclusions: This survey study could trigger active operational researches for OR efficiency. It might help hospital policy makers manage OR resources more efficiently.
수술 후 일반 내외과계 중환자실로 입실한 환자들에 대한 후향적 분석
윤준로,임춘학,김미정 대한중환자의학회 2008 Acute and Critical Care Vol.23 No.1
Background: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. Methods: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus` suggestion which defines the kinds of treatment done exclusively in ICU. Patients` demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. Results: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. Conclusions: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.
클립을 이용한 교감신경 차단술이 자율신경계 기능에 영향을 미치는가?
김혜영,임춘학,이혜원,임혜자,윤석민,장성호 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.3
Background: A thoracic sympathicotomy with cauterization has been reported to decrease cardiac sympathetic activity. The purpose of this study was to investigate immediate changes in autonomic function after thoracic sympathicotomy by clipping. Methods: Autonomic function test such as heart rate response to deep breathing (HRDB), Valsalva ratio (VR), 30/15 ratio and systolic blood pressure change response to standing (△SBP) were measured before (baseline) and 2 hr after the T3-4 sympathicotomy by clipping in 12 patients with palmar hyperhidrosis. Baseline data were also compared with data obtained from 18 matched patients who were planned to take minor surgery. Anesthesia was induced with 5 mg/kg thiopental sodium and 0.6 mg/kg rocuronium. The anesthesia was maintained with 2.0-2.5 vol% sevoflurane, 2 L/min nitrous oxide and 2 L/min oxygen. Results: There were no significant differences of the autonomic test results between control and clip group before operation. In the clip group, there were no significant differences of autonomic test results between before and after clipping. Conclusions: This study showed that the response to sympathetic stimulation was not changed after thoracic sympathicotomy by clipping. (Korean J Anesthesiol 2006; 50: 292~5)
한국형 박동식 생명구조장치(T-PLS) 순환회로를 위한 최적화 모델 연구
선경,황진욱,임춘학,손호성,이정주,이혜원,김광택 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.10
배경: 체외순환장치 중 막형산화기를 사용하는 인공심폐기나 생명구조장치(Extra-corporeal Life Support System; ECLS)는 혈액이 통과하기 위해 막형산화기 전방에 구동펌프가 요구된다. 국내에서 개발된 박동식 생명구조장치(T-PLS)의 경우는 막형산화기가 두 개의 혈액주머니 사이에 위치하여 액츄에이터가 번갈아 짜내는 구조로 되어 있다. 저자 등은, 만일 저항이 낮은 gravity-flow hollow fiber 막형산화기를 사용한다면 두 개의 혈액주머니와 박동펌프를 막형산화기 후방에 설치하는 것이 가능하며, 이러한 구조는 같은 펌프박동 조건에서 2배의 맥박수를 보장하므로 펌프박출량이 증가될 것으로 가정하였다. 본 실험은 한국형 생명구조장치의 회로구성을 최적화하기 위해 계획되었으며, 기존의 막형산화기를 사용한 직렬회로구조와 gravity-flow hollow fiber 막형산화기를 이용한 병렬회로 구조를 박동에너지와 펌프박출량을 이용하여 비교하였다. 대상 및 방법: 실험은 35∼45 kg의 돼지 12마리에서 심실세동혈 심정지 모델을 만들었으며, T-PLS 회로구성 형태에 따라 두 군으로 나누었다. 직렬군은 두 개의 혈액주머니 중간에 기존 막형산화기를 직렬로 설치하였으며, 병렬군은 gravity-flow hollow fiber 막형산화기 후방에 이중구동펌프를 병렬로 설치하였다. 펌프박출량은 대동맥 도관에서 직접 혈류를 측정하였고, 등가압력에너지(EEP)는 실시간으로 컴퓨터에 저장된 펌프박출곡선과 하행대동맥 혈압곡선에서 계산하였다. 각 지표는 펌프속도 30, 40, 50 BPM에서 매번 측정하였다. 결과: 두 군 모두 박동에너지 측면에서 충분한 박동성을 보여주었다. 펌프속도 30, 40, 50 BPM에서 EEP와 평균동맥압의 변화율은 병렬군의 경우 13.0 .7%, 12.0 1.9%, and 7.6 0.9% 였으며, 직렬군의 경우 22.5 2.4%, 23.2 1.9%, and 21.8 1.4%였다. 펌프박출량의 경우는 펌프속도 40, 50 BPM에서 병렬군의 경우 3.1 0.2 and 3.7 0.2 L/min였으며, 직렬군의 경우 2.2 0.1 and 2.5 0.1 L/min였다(p<0.05). 결론: 혈류 저항이 낮은 gravity-flow 막형산화기를 사용하여 T-PLS 구동펌프를 병렬회로로 배치할 경우 효과적인 박동성은 유지하면서, 기존의 막형산화기를 이용한 직렬회로 구조에 비해 펌프박출량을 증가시켰다.