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임상연구 : 체외순환 없는 관상동맥우회술 중 지속적 우심실용적 감시가 가능한 폐동맥카테터로 측정한 전부하 지표들은 일회박출량지수를 반영하는가?
이지연 ( Ji Yeon Lee ),방서욱 ( Sou Ouk Bang ),심재광 ( Jae Kwang Shim ),이종화 ( Jong Hwa Lee ),원영주 ( Young Ju Won ),곽영란 ( Young Lan Kwak ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: It is important to assess cardiac preload for management of patients undergoing off pump coronary artery bypass surgery (OPCAB). Recently, several studies have documented the good correlation between right ventricular end-diastolic volume index (RVEDVI) and stroke volume index (SVI), compared with cardiac filling pressures. However, none of these studies have evaluated relationship between predictors of preload and SVI measured with volumetric pulmonary artery catheter during OPCAB. The correlation of continuous RVEDVI and SVI measured with volumetric pulmonary artery catheter during OPCAB was evaluated in this study. Methods: Fifty three patients undergoing OPCAB were included. Hemodynamic parameters were measured 10 min after induction (T1), 10 min after Y-graft formation started (T2) and 10 min after sternum closure (T3). The correlation of parameters were assessed by simple linear regression. Results: Central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) did not correlate with SVI during OPCAB. On the other hand, a statistically significant result was found between RVEDVI and SVI at T2 (r2 = 0.133, P = 0.007) and T3 (r2 = 0.380, P < 0.000). But RVEDVI and SVI were weakly correlated. And at T1, RVEDVI and SVI did not correlate. Conclusions: RVEDVI is a more reliable predictor of preload compared to CVP and PAOP during OPCAB. But in post-induction period (T2), RVEDVI did not correlate with SVI. (Korean J Anesthesiol 2007; 53: 206~11)
임상연구 : 판막수술을 시행 받는 환자에서 레닌-안지오텐신계 길항제가 체외순환 후 요골-대퇴동맥압 간의 차이에 미치는 영향
김대희 ( Dae Hee Kim ),곽영란 ( Young Lan Kwak ),이종화 ( Jong Hwa Lee ),심재광 ( Jae Kwang Shim ),차재호 ( Jae Ho Cha ),방서욱 ( Sou Ouk Bang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: Femoral to radial arterial pressure gradient (△P) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on △P after CPB in patients undergoing valvular heart surgery. Methods: Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure. Results: After CPB, systolic △P was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic △P more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups. Conclusions: Preoperative treatment with RAS-A resulted in clinically significant △P after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery. Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients. (Korean J Anesthesiol 2007; 53: 199~205)
김창석 ( Chang Seok Kim ),곽영란 ( Young Lan Kwak ),김대희 ( Dae Hee Kim ),라세희 ( Se Hee Na ),심재광 ( Jae Kwang Shim ),방서욱 ( Sou Ouk Bang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: Hydroxyethyl starch (HES) effectively restores plasma volume and thereby enhances microcirculation and tissue oxygenation at the expense of coagulation impairment. These effects are related to molecular weight, substitution and C2:C6 ratio. But, most of the studies regarding coagulation impairment in cardiac surgeries were performed in patients undergoing cardiopulmonary bypass which significantly causes coagulation derangements. Therefore, we have evaluated the effects of 2 different HES solutions on tissue oxygenation and postoperative bleeding in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Methods: Forty four patients were prospectively enrolled. After the induction of anesthesia, either HES 130/0.4 (V group) or 200/0.5 (H group) were infused for fluid therapy to maintain predetermined urine output, cardiac index and filling pressure up to 16 h after the surgery. Tissue oxygenation profiles and respiratory parameters were recorded after induction of anesthesia, completion of distal anastomosis and sternum closure, upon admission at intensive care unit, and 4 h thereafter. The amounts of chest tube drainage, transfusion and fluid balance were measured up to 16 h after the surgery. Results: Patients` demographic data were similar between the groups. Tissue oxygenation profiles, respiratory parameters, hemodynamics, and time to extubate were not different between the groups. However, chest tube drainage and transfusion requirements were significantly less in the V group. Conclusions: In OPCAB, 6% HES 130/0.4 causes less postoperative bleeding and transfusion requirement and has a comparable efficacy on hemodynamic stability, pulmonary function and tissue oxygenation when compared to 6% HES 200/0.5. (Korean J Anesthesiol 2007; 52: 649~56)
증례보고 : 대동맥판막치환술을 위한 체외순환 이탈 후 경식도심초음파 검사에서 발견된 좌심방귀 내의 혈전
김대희 ( Dae Hee Kim ),곽영란 ( Young Lan Kwak ),심재광 ( Jae Kwang Shim ),오영준 ( Young Jun Oh ),최영림 ( Yeong Rim Choi ),방서욱 ( Sou Ouk Bang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Intraoperative transesophageal echocardiography (TEE) during cardiac surgery is an invaluable procedure, which aids hemodynamic management as well as surgical directions. TEE adds valuable information to the assessment of cardiac structures and in contrast to transthoracic echocardiography (TTE), due to its proximity to left atrium (LA), it is especially useful in detection of mass lesions in the LA. The following case describes a patient undergoing aortic valve replacement under cardiopulmonary bypass with low risk of thrombi formation and undetected thrombi in the LA appendage by preoperative TTE. These thrombi could be detected by intraoperative TEE and removed at the same operation, thus avoiding thromboembolic complication and second operation. (Korean J Anesthesiol 2007; 52: 596~9)
개심술 시 마취유도제로서의 Midazolam Malate
오흥근,방서욱 대한마취과학회 1983 Korean Journal of Anesthesiology Vol.16 No.2
Midazolm, a water-soluble benzodiazpine that is shorter-acting, more potent, and less irri-tating toveins than diazepam, has been suggested for use for inducation of anesthesia. The cardiovascular effect of an induction dose(0.2~03mg/kg) of midazolam in ASA class 111cardiac surgical patients(N=15) were compared in a double-blind fashion with a similar group og patients(N=15) receiving thiopental(5.0mg/kg). The patients were premedicated by triflupromazine, pethidine, hydroxyzine, atropine and diazepam. The results were summarized as follows. 1) The thiopental group were more decreased in blood pressure and increase in heart rates than midazolam group. 2) Spontaneous eye closing time and loss of eyelash reflexe were observed. But those were a poor sign of adequate inducation because of heavy preanesthetic sedation. 3) The changes of blood pressure and puls rate after induction and intubation were almost, depends on preload state before inducation. From the above results, midazolam was sufficient as an induction agent for open heart cases. But a hypovolemic patients and completely beta blocked patiens should be used cautiously because they may be developed severe hypotention and tachycardia
선천성 심기형아에서 Pressure-Limit Control Accessary 를 이용한 Anesthetic Drager Infant Ventilator 의 유용성
박정현,방서욱,윤동명,유은숙 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.4
Pressure-limit ventilators are used because it is believed that they decrease the incidence of pulmonary gas leaks and chronic lung disease. The disadvantage of pressurelimit ventilators is that there is no automatic compensation for changes in compliance and resistance of the lung and the chest wall. Consequently, if lung compliance decreases, tidal volume will decrease and blood gases will worsen. The aim of this study is to find the adequacy for the oxygenation and ventilation of volume-limit ventilator with pressure-limit control accessary in pediatric patient with congenital heart disease. The pressure-limit control accessary for anesthetic ventilator(AV-E, North America Drager, Bedford, USA) in 36 pediatric patients undertaken open heart surgery and thoracotomy, retrospectively, were employed. The patients were divided into 3 groups according to their body weights. The respiratory rate of group I ($lt;5 kg, n=12) was 25/min, group II(≥5, $lt;10 kg, n=6) was 20/min and group III(≥10, $lt; 20 kg, n=8) was 15/minThe patients were divided into another 2 groups, A(n=30) or B(n=6), with the supine or lateral, respectively according to the operation position. The results showed all the values of arterial blood gases almost within normal limits, except one patient in each group. We concluded that anesthetic Drager infant ventilator with pressure-limit control accessary was useful during controlled ventilation, and this is suitable for the prolonged operation in pediatric patients with the supine or lateral position.