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임상연구 : 간우엽 공여술 후 혈액응고 상태의 변화와 경막외 카테터 사용 시의 의미
최수주 ( Soo Joo Choi ),곽미숙 ( Mi Sook Gwak ),김갑수 ( Gaab Soo Kim ),이준용 ( Jun Yong Lee ),김태형 ( Tae Hyeong Kim ),김진경 ( Jin Kyung Kim ),김정수 ( Chung Soo Kim ),정익수 ( Ik Soo Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: Living donors for liver transplantations may have a low pain threshold and should be given effective postoperative pain control. However, epidural catheterization has been the subject of intense debate because of the possibility of severe coagulation derangement after a right hepatectomy. This study examined the changes in the coagulation status in right lobe donors. Methods: The charts and computerized hospital data of 261 consecutive living donors who had undergone right hepatectomy were retrospectively reviewed. The coagulation profile including the platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) was analyzed at the preoperative period, immediately after surgery, and 5 days after surgery. Results: The platelet count decreased significantly from immediately after surgery until postoperative day (POD) 5 (P < 0.001). Nineteen donors (7.3%) had a minimum platelet count of < 100 × 103/mm3, and no case showed a platelet count of < 50 × 103/mm3. The PT increased significantly and reached at peak at POD 1 (1.56 ± 0.19 INR), and the PT values until POD 5 were significantly different from the preoperative values (P < 0.001). However, the peak PT was > 2.0 INR in only 4 donors (1.5%). The aPTT immediately after surgery showed severe prolongation (P < 0.001), but recovered rapidly on POD 1. Conclusions: Right lobe donors showed postoperative coagulation derangement but the changes appear to be acceptable for the maintenance and removal of the epidural catheters. These results suggest that careful epidural catheterizations are relatively safe in right lobe donors. (Korean J Anesthesiol 2006; 51: 685~9)
증례보고 : 소장 절제술을 시행받은 환아에서의 소장 이식 수술의 마취 관리
김한수 ( Han Soo Kim ),김형균 ( Hyung Kyun Kim ),김지애 ( Jie Ae Kim ),방시라 ( Si Ra Bang ),김갑수 ( Gaab Soo Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Small bowel transplantation is becoming the treatment of choice for short-gut syndrome. Improvements in surgical techniques, immunosuppressants, and anesthetic management of patients have allowed this procedure to become the standard of treatment for patients who are unable to continue total parenteral nutrition (TPN) therapy due to TPN-associated complications. We experienced small bowel transplantation in a 10-month-old male infant who had small bowel resection for small bowel volvulus and has suffered from complications such as recurrent sepsis, disseminated intravascular coagulation (DIC) due to long-term TPN. We report our experience with a brief review of the relevant literature. (Korean J Anesthesiol 2007; 53: 791∼5)
심폐우회술시 Roller Pump 와 Centrifugal Pump 사용에 따른 혈액학적 차이
김지연,김유홍,함병문,곽미숙,김갑수,김정수,박계현 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.6
Background: Prolonged extracorporeal circulation entails tremendous threats of red cell lysis, severe bleeding problems due to platelet injury and activation, and endothelial damages by sequestered leukocytes. In consideration of these problems, a new centrifugal pump was developed and tested clinically to evaluate its effectiveness. Methods : We compared the effects of a centrifugal pump with those of a roller pump on hematological responses during cardiopulmonary bypass(CPB) in 20 coronary artery bypass surgery patients. The patients were divided into two groups of 10 each. The studied parameters included WBC counts, platelet counts, plasma Hb and D-dimer. Blood samples were taken after sternotomy, at 60 min, 120 min and 180 min after CPB start, and at 2 hr after CPB stop. Results : No differences between the groups were found in bypass time, aortic cross clamp time, extracorporeal circulation flow and hematocrit. The centrifugal pump group demonstrated less platelet depletion(p<0.05), hemolysis(plasma Hb,p<0.05) and fibrinolysis(D-dimer, p<0.05). These differences were CPB time dependent and became statistically significant after 120 min bypass. Conclusions: We conclude that roller pump still can be safely used for standard cardiac procedures with bypass time less than 120 minutes and the centrifugal pump has significant potential to be safely applied to CPB for long ypass time in order to avoid postperfusion syndrome. (Korean J Anesthesiol 1998; 34: 1208∼1215)
소아중환자에 대한 고찰 : 1986 년부터 1992 년 까지 from 1986 to 1992
김종성,김성덕,김희수,김갑수 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.9
A retrospective analysis was performed on the 5877 critically ill pediatric patients who had been admitted to Pediatric Intensive Care Unit (PICU) of Seoul National University Children's Hospital (SNUCH) from 1986 to 1992. Total PICU beds are 17 and 10 of 17 are used by patients in the department of thoracic surgery. The purpose of this study was to provide a guide to the management of Pediatric Intensive Care Unit (PICU). This study resulted in follows: 1) Number of yearly admitted patients, mean number of daily admitted patients, and mean duration of stay per patient were increased steadily year by year. 2) Yearly fatality rate of the PICU patients during this period was also increased and the mean was 9.3%. Yearly fatality rate of patients in the department of pediatrics was 24.1% and the highest than any other surgical departments. 3) Neonates' fatality rate in PICU during same period was 17.8% which was the highest than any other age groups. 4) Regarding the duration of admission, patients who admitted for more than 8days were in high risk group and their mean fatality rate was 13.2% for 7 years. 5) The mean fatality rate was 9.1% for males, 9.7% for females.
Gaab Soo Kim,Hyun Joo Ahn,김원호,김민지,이상현 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.2
Purpose: Open infrarenal abdominal aortic aneurysm (AAA) repair is performed without event in most cases. However, some patients suffer major morbidities such as renal failure, myocardial infarction, paraplegia, acute respiratory distress syndrome,or hepatic dysfunction. Predicting what kinds of patient populations are more prone to develop such complications may keep the clinicians more attentive to the patients, possibly leading to better prognoses. In this retrospective study, we searched the incidence of and risk factors for postoperative complications and their predictive equations in 162 patients who underwent open infrarenal AAA repair. Materials and Methods: Postoperative complications were observed within 30 days. Patient characteristics, types of aneurysm and surgery, and hemodynamic and metabolic variables during the periclamp period were analyzed in relation to postoperative complications using multiple logistic regression analysis. Results: Postoperative complications involved the cardiac (20%), pulmonary (14%), renal (13%), gastrointestinal (6%), hepatic (3.1%), and neurologic (2.5%) systems, and bleeding occurred in 1.2% of cases. The mortality rate was 5.6%. The risk factors were age [> 67 yrs, odds ratio (OR) 2.6], clamp duration (> 110 min, OR 4.7), volume of blood transfusion (> 1,280 mL, OR 4.4), emergency operation (OR 1.4), and vasopressor infusion during clamp (OR 1.4). The prediction model was: P(x) = exp(a)/[1 + exp(a)] a;-2.2 + 0.9 × age + 1.5 × clamp duration + 1.5 × transfusion + 0.3 × emergency + 0.4 × vasopressor infusion [insert 1 if risk factors exist, otherwise,insert 0 to each variable]. Conclusion: A significant number of complications occurred after infrarenal AAA repair. Therefore, creating a protocol to identify and monitor high risk patients would improve postoperative care.
Kim, Jong Man,Kim, Sung-Joo,Joh, Jae-Won,Kwon, Choon Hyuck David,Song, Sanghyun,Shin, Milljae,Moon, Ju Ik,Kim, Gaab Soo,Hong, Seung Heui,Lee, Suk-Koo W.B. Saunders Co 2011 Liver transplantation Vol.17 No.4
<P>Cytomegalovirus (CMV) infections contracted after liver transplantation put patients at an increased risk of morbidity and mortality. We analyzed the effects of CMV infection by time of onset, mortality, and graft failure risk factors in liver recipients who were CMV donor-positive/recipient-positive (D+/R+). We reviewed 618 medical records for consecutive adult liver transplant cases. CMV pp65 antigenemia assays to determine patient CMV status were administered monthly. The incidences of CMV infection and disease were 55.7% (344 of 618 records) and 5.5% (34 of 618 records), respectively. The differences in patient survival and graft failure rates for CMV-infected and CMV-uninfected patients were not significant (P = 0.707 and P = 0.973), but the rates were lower in patients with CMV disease than in CMV-uninfected patients (P = 0.005 and P = 0.030, respectively). The recurrence of hepatitis B virus and hepatocellular carcinoma, hepatic dysfunction, infection, numerous pp65-staining cells, and CMV disease were found to be the risk factors for mortality and graft failure in CMV D+/R+ adult liver transplant patients. In conclusion, the occurrence of CMV disease, and not asymptomatic CMV infection, was a risk factor for mortality and graft failure in adult liver transplant recipients with CMV D+/R+. Liver Transpl, 2011. © 2011 AASLD.</P>
임상연구 : 주술기에 발생하는 압력에 의한 피부 손상의 발생률과 위험 인자의 조사
최수주 ( Soo Joo Choi ),김대원 ( Dae Won Kim ),정혜선 ( Hye Seon Chung ),안현주 ( Hyun Joo Ahn ),곽미숙 ( Mi Sook Gwak ),양미경 ( Mi Kyung Yang ),이상민 ( Sang Min Lee ),김갑수 ( Gaab Soo Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Pressure-induced skin breakdown is not only a painful inconvenience to the patient, but it is also associated with a prolonged hospital stay. This study examined the incidence of pressure-induced skin breakdown in attempt to identify the associated risk factors during elective surgery. Methods: Data were collected from 808 subjects who underwent orthopedic, thoracic, neuro- or plastic surgery over a six-month period. The data included age, gender, weight, height, body mass index, ASA status, surgical position, operation time, estimated blood loss, preoperative hemoglobin concentration, serum albumin, co-morbidity, and intraoperative hypotension. The patient`s skin was inspected closely within 24 hours after surgery. The sites and severity of skin breakdown were assessed. Results: Of the 808 patients in this study, 192 patients (23.8%) developed skin breakdown during surgery. The incidence of blisters, abrasion, or blister and abrasion was 6.1%. The patient`s weight, operation time, estimated blood loss, malignancy, and intraoperative hypotension were significantly related to the development of skin breakdown (P < 0.05). The incidence of pressure-induced skin breakdown was highest in the prone position (P = 0.000). Age, gender, body mass index, hypertension, diabetes, preoperative hemoglobin and albumin level were not found to be risk factors of skin breakdown. Conclusions: The early identification of a patient at risk is a first step in a scientifically based approach for preventing the development of pressure sores. Although intervention will not always prevent the development of pressure sores, a medical team must recognize the risk factors associated with skin breakdown and carry out careful intervention during the perioperative period. (Korean J Anesthesiol 2006; 50: 525~9)