The Skin-to-epidural distance of parturients by ultrasonography: sitting position versus left lateral position

천은희,정락경,김윤진,진소희 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.2

Background: Pre-procedural lumbar ultrasound scanning is a reliable tool to estimate the skin to epidural distance (SED). We conducted an observational study to compare the SED between the sitting position and lateral position using pre-procedural ultrasound imaging of the lumbar spine in parturients. Methods: Using a 2–5 MHz curvilinear transducer, we obtained images of the lumbar interspaces from L2-3 to L5-S1 in the paramedian sagittal oblique view. The individual distance from the skin to the ligamentum flavum-dura mater unit was measured at the level of L2-3, L3-4, L4-5, and L5-S1 in the left lateral position (distance in lateral position; D-lat). Subsequently, participants were placed in the sitting position, and the distance was measured in the same manner (distance in sitting position; D-sit). Data were grouped according to body mass index (BMI; kg/m2) measurements of ≥ 25 or < 25 and analyzed. The primary outcome was the change determined by ultrasound between D-lat and D-sit at the same lumbar level according to position. Results: Thirty parturients were studied. The difference between D-lat and D-sit in the same lumbar level was not statistically significant. The mean changes between D-lat and D-sit in the same lumbar level were less than 0.18 cm. In BMI ≥ 25 group, the difference between D-lat and D-sit were greater than that of BMI < 25 group at L3-4 level (P = 0.042). Conclusions: It is important for clinicians to consider that position change is associated with greater differences in SED in obese parturients (BMI ≥ 25) compared with thin parturients (BMI < 25). For obese parturients, the sitting position may be helpful.

전자간증 임산부에서 황산마그네슘의 사용이 분만 시간 및 신생아 상태에 미치는 영향

천은희,도상환,신현정,나효석,황정원 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.2

Background: Magnesium sulfate (MgSO4) is a drug of choice forwomen with preeclampsia, with evidence that it reduces progressionto eclampsia and maternal mortality. However, no previous studieshave been conducted on the effect of magnesium sulfate on labor. This retrospective study investigated the effect of magnesium sulfateon the labor duration and the neonatal outcomes in parturients withpreeclampsia. Methods: We reviewed the medical records of 209 women whodelivered vaginally with the diagnosis of preeclampsia from January1, 2003 to June 30, 2013. They were divided into two groups,primipara (Primi group) and multipara (Multi group). Then, eachgroup was subclassified as MgSO4-treated (Mg group) andMgSO4-untreated group (Cont group) again. Collected data includedthe duration of each stage of labor and neonatal outcomes. Results: The duration of the 1st stage of labor was significantlylonger in the Multi-Mg group, compared with the Multi-Cont group(138 ± 149 min vs. 88 ± 92 min, P = 0.025). However, the totallabor durations were comparable between the two groups. Primigroup had no difference in durations of any stage of labor and thetotal duration. Neonates showed worse outcomes (lower birthweight, lower Apgar, higher NICU admission rate) in the Primi-Mggroup than the Primi-Cont group. Conclusions: Although preeclamptic multiparous parturientstreated with MgSO4 showed longer 1st stage of labor than thoseuntreated with MgSO4, the total labor durations were comparablebetween the groups.

Bradley-Terry 모형에 의한 배구 팀들의 전력분석 : 한국배구 '98-'99 슈퍼리그 자료를 통하여

천은희,신영진 목원대학교 1999 통계학술논집 Vol.14 No.-

따뜻한 아이스크림

천은희 샘터사 1999 월간 샘터 Vol.30 No.1

양측 슬관절 전치환술시 척추경막외병용마취가 스트레스 반응에 미치는 영향

천은희 ( Eun Hee Chun ),김종학 ( Jong Hak Kim ),백희정 ( Hee Jung Baik ),김윤진 ( Youn Jin Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3

Background: Intraoperative stress may evoke various changes in hormonal secretion and autonomic nervous system activity. We designed this study to investigate the effect of combined spinal-epidural anesthesia on stress hormone responses. Methods: Thirty women more than 60 years of age, undergoing bilateral total knee replacement surgery were studied. Patients were randomized to receive either general anesthesia (group I), or combined spinal-epidural anesthesia (group II). Blood samples were obtained immediately before anesthesia induction, immediately after skin incision, after first knee prosthesis insertion, and end of operation, immediately for measurement of cortisol, epinephrine, and norepinephrine. Results: The plasma concentration of cortisol, epinephrine and norepinephrine were significantly lower in group II after the prosthesis insertion and at the end of operation, immediately. The plasma concentration of cortisol was significantly higher than basal values in both of two groups through the surgery. Conclusions: Combined spinal-epidural anesthesia has the blocking effect of releasing catecholamine during total knee replacement surgery and immediately after the surgery. The effect of combined spinal-epidural anesthesia on stress responses during total knee replacement is better than that of general anesthesia. (Korean J Anesthesiol 2009;57:296∼301)

척추-경막외 병용마취로 제왕절개술시 산소투여방법에 따른 태아의 산소화

천은희 ( Eun Hee Chun ),김종학 ( Jong Hak Kim ),김윤진 ( Youn Jin Kim ),백희정 ( Hee Jung Baik ),전주현 ( Joo Hyun Jun ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6

Background: During cesarean section under regional anesthesia, it is current practice to provide the parturient with a source of supplemental oxygen. We compared the effect of high flow oxygen by mask with that of low flow oxygen by nasal prongs. Methods: Fifty eight parturients presenting for elective cesarean section under combined spinal-epidural anesthesia were randomly assigned to one of the three groups to be given either oxygen 4 L/min by mask, oxygen 8 L/min by mask or oxygen 2 L/min by nasal prongs. Umbilical arterial and venous blood samples were taken and analysed immediately after delivery. Results: There were no significant differences in the umbilical arterial or venous pH, partial pressure of oxygen and partial pressure of carbon dioxide among the three groups. In neonatal outcome, there were no differences in Apgar scores. Conclusions: It makes no differences whether the parturients received supplemental oxygen by nasal prongs or simple face mask during cesarean section under combined spinal-epidural anesthesia. (Korean J Anesthesiol 2009; 57: 709∼13)

제왕절개 전신마취 시 Isoflurane과 Sevoflurane이 임산부의 각성에 미치는 영향

천은희 ( Eun Hee Chun ),김종학 ( Jong Hak Kim ),백희정 ( Hee Jung Baik ),김윤진 ( Yun Jin Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.5

Ultrasound measurement of the vertebral level of Tuffier’s line in elderly women

김동연,천은희,김지은,김윤진,김종학,정락경,한종인 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.5

Background: It would be imprecise to generalize the vertebral level determined by palpation to patients of all ages. The purpose of this study was to compare the vertebral level passed by Tuffier’s line in elderly women with that passed in adult women using ultrasound in the left lateral decubitus flexed position. Methods: We enrolled 50 female patients over the age of 65 (elderly group) and 50 female patients between ages 20 and 50 (control group) who had been scheduled to undergo spinal anesthesia. Using ultrasound, we marked the L2–5 lumbar spinous processes and intervertebral spaces. The most cephalad part was labeled 1 and the most caudal part was labeled 11. We then identified which line of these vertebral levels Tuffier’s line crossed. Results: The median value of the numbers signifying the vertebral level of Tuffier’s line was 3 (the L2–3 intervertebral space) in the elderly group, while it was 8 (the lower part of the L4 vertebra) in the control group. The vertebral level of Tuffier’s line had statistically significant correlations with age, body mass index, and weight in the elderly group (P < 0.001). Conclusions: The vertebral level of Tuffier’s line determined with ultrasound measurement in the left lateral decubitus flexed position was more cephalad in the elderly women than in those of the control group. Therefore, we should consider that the needle could be inserted at a higher level than expected, and use care in determining the level of needle insertion during spinal anesthesia in elderly women.

Postoperative hypothermia in geriatric patients undergoing arthroscopic shoulder surgery

이귀용,천은희,김치효 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.1

Background: Hypothermia below 36°C is a common problem during arthroscopic shoulder surgery. Geriatric patients are more vulnerable to perioperative hypothermia. The present study compared postoperative hypothermia between geriatric and young adult patients receiving arthroscopic shoulder surgery. Methods: Data were collected retrospectively from a geriatric group (aged 65 or more, n = 29), and a control group (aged 19–64, n = 33) using the anesthesia records of patients who had undergone arthroscopic shoulder surgery. The primary outcome measure was the incidence of hypothermia upon arrival in the postanesthesia care unit (PACU). The secondary outcome measure was the decrease in body temperature from admission into the operating room to admission into the PACU. Results: The incidence of hypothermia was 93.1% and 54.5% in the geriatric and control groups, respectively, demonstrating a significant difference between the groups (P < 0.001). Comparison between body temperature revealed a decrease of 1.5 ± 0.6°C and 1.0 ± 0.4°C in the geriatric and control groups, respectively, showing a significant difference between the groups (P < 0.001). The degree of hypothermia was significantly different between the groups (P = 0.027). No shivering was observed in either of the two groups, but the incidence of thermal discomfort was higher in the geriatric group than in the control group (P = 0.021). Conclusions: In geriatric patients undergoing arthroscopic shoulder surgery, both the incidence of postoperative hypothermia and the associated temperature drop are more prominent than those in young adult patients. Additional warming methods will be needed to prevent postoperative hypothermia in geriatric patients.

Effect of short-term prewarming on body temperature in arthroscopic shoulder surgery

신광섭,이귀용,천은희,김윤진,김원중 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.4

Background: Hypothermia (< 36°C) is common during arthroscopic shoulder surgery. It is known that 30 to 60 minutes of prewarming can prevent perioperative hypothermia by decreasing body heat redistribution. However, the effect of short-term prewarming (less than 30 minutes) on body temperature in such surgery has not been reported yet. Therefore, the aim of this prospective study was to investigate the effect of short-term prewarming for less than 30 minutes using forced-air warming device on body temperature during interscalene brachial plexus block (ISBPB) procedure in arthroscopic shoulder surgery before general anesthesia. Methods: We randomly assigned patients scheduled for arthroscopic shoulder surgery to receive either cotton blanket (not pre-warmed, group C, n = 26) or forced-air warming device (pre-warmed, group F, n = 26). Temperature was recorded every 15 minutes from entering the operating room until leaving post-anesthetic care unit (PACU). Shivering and thermal comfort scale were evaluated during their stay in the PACU. Results: There were significant differences in body temperature between group C and group F from 30 minutes after induction of general anesthesia to 30 minutes after arrival in the PACU (P < 0.05). The median duration of prewarming in group F was 14 min (range: 9–23 min). There was no significant difference in thermal comfort scale or shivering between the two groups in PACU. Conclusions: Our results showed that short-term prewarming using a forced-air warming device during ISBPB in arthroscopic shoulder surgery had beneficial effect on perioperative hypothermia.