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지성미,Cho Chaemin,Choi Gunhwa,송재격,권민아,박정헌,김석곤 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.3
Background: Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case: Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications. Conclusions: REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.
지성미,김성훈,남재식,윤혜주,최정현,이은호,최인철 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.3
Background: The early detection of coagulopathy helps guide decisions regarding optimal transfusion management during cardiac surgery. This study aimed to determine whether rotational thromboelastometry (ROTEM) analysis during cardiopulmonary bypass (CPB) could predict thrombocytopenia and hypofibrinogenemia after CPB. Methods: We analyzed 138 cardiac surgical patients for whom ROTEM tests and conventional laboratory tests were performed simultaneously both during and after CPB. An extrinsically activated ROTEM test (EXTEM), a fibrin-specific ROTEM test (FIBTEM) and PLTEM calculated by subtracting FIBTEM from EXTEM were evaluated. Correlations between clot amplitude at 10 min (A10), maximal clot firmness, platelet count, and fibrinogen concentrations at each time point were calculated. A receiver operating characteristic analysis with area under the curve (AUC) was used to assess the thresholds of EXTEM, PLTEM and FIBTEM parameters during CPB and for predicting thrombocytopenia and hypofibrinogenemia after weaning of CPB. Results: The A10 on EXTEM, PLTEM, and FIBTEM during CPB showed a good correlation with platelet counts (r = 0.622 on EXTEM and r = 0.637 on PLTEM; P < 0.0001 for each value) and fibrinogen levels (r = 0.780; P < 0.0001) after CPB. A10 on a FIBTEM threshold of 8 mm during the CPB predicted a fibrinogen concentration < 150 mg/dl (AUC = 0.853) after CPB. Additionally, the threshold level of A10 on EXTEM during CPB for predicting platelet counts < 100,000 /μl after CPB was 42 mm (AUC = 0.768). Conclusions: EXTEM, PLTEM, and FIBTEM parameters during CPB may be useful for predicting thrombocytopenia and hypofibrinogenemia after weaning of CPB.
복강경하 자궁적출술 시 기관내튜브 기낭팽창법 중 공기풍선촉진법과 최소기낭용적팽창법이 수술 후 인후통에 미치는 효과 비교
최연희,지성미,윤석화,박상일 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4
Background: Inadequate tube cuff inflation during tracheal intubation can cause complications. Laparoscopic surgery requiring Trendelenburg positioning and maintaining pneumoperitoneum can also result in complications. The focus of our study was to compare the connection between postoperative sore throat and pressure changes associated with methods involving cuff inflation. Methods: Sixty gynecologic patients undergoing laparoscopic surgery were subjected to the study. The patients were divided into two groups, P and M. Endotracheal tube cuffs were inflated with the pilot balloon palpation technique in group P, while cuffs in group M were inflated with the minimally occlusive volume technique. Cuff pressures were measured with a portable manometer after intubation and before reversing muscle relaxation. Anesthesia was maintained with sevoflurane and N2O. Postoperative sore throat and voice changes were recorded from the PACU until one day after surgery. Results: Initial and final cuff pressure in group P was significantly higher than group M (P < 0.05). Frequency of sore throat and voice change both in the PACU and one day after surgery were higher in group P. Sore throat in group P in the PACU showed higher frequency of grade 2 and 3 than group M. Conclusions: Minimally occlusive volume technique caused less of an increase in cuff pressure than the pilot balloon palpation technique, resulting in less complications such as sore throat. Therefore, this technique is helpful in reducing postoperative sore throat and complications during laparoscopic surgery. However, it is noted that these assumptive methods are less accurate than direct measurement with a manometer.
이관우,홍성만,지성미,이정국,권민아,박정헌,김석곤 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.2
Background: Endotracheal intubation often causes sore throat and coughing. The aim of this study was to decrease the incidence and severity of cough, sore throat, and hemodynamic changes after extubation by endotracheal administration of 1% lidocaine. Methods: Sixty patients physical status American Society of Anesthesiologists classes I, II, and III who received a surgery under general anesthesia were randomly divided into two groups. L group was given 1% lidocaine 0.5 mg/kg by endotracheal administration. The other group, N group, received the same volume of normal saline. The number of cough, the severity of sore throat with numerical rating score (NRS), incidence of local anesthetic systemic toxic reaction, laryngospasm, and hoarseness were recorded. In addition, the number of coughs was divided into three levels by its severity, and it was converted into an indicator of cough score. Results: L group had a significantly lower number of cough and sore throat NRS (P value < 0.05) than the N group, and also hoarseness did not occur. The changes in the hemodynamic parameters, before and after the emergence of anesthesia, were more stable in the L group than those in the N group, but not statistically significant. Conclusions: The results of this study suggest that endotracheal administration of 1% lidocaine is effective and safe method to reduce cough and sore throat caused by extubation.
Laryngeal granulomas in patients after two-jaw surgery - Four cases report -
송재격,조원호,지성미,박정헌,김석곤 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.4
Background: Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it. Case: We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature. Conclusions: There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.