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증례보고 : Child-Pugh Class B 간경변 환자의 대동맥 판막 치환술, 삼첨판 성형술과 심실 중격 결손 봉합의 마취 경험
안여현 ( Yeo Hyun Ahn ),김지연 ( Ji Yeun Kim ),이상일 ( Sang Il Lee ),김경태 ( Kyung Tae Kim ),최원주 ( Won Joo Choe ),박장수 ( Jang Su Park ),김정원 ( Jung Won Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Open heart surgery under cardiopulmonary bypass (CPB) in patients with liver cirrhosis is prone to the development of various complications associated with high mortality rates. According to recent studies, patients with advanced cirrhosis (Child-Pugh class B or C cirrhosis) have a significantly higher mortality rate (50-100%) after open heart surgery under CPB. We report the anesthetic management of cardiac surgery using CPB of 61-year-old man with aortic valve regurgitation, tricuspid regurgitation and ventricular septal defect (VSD) who had complicated by liver cirrhosis of Child-Pugh class B. The patient underwent successfully aortic valve replacement, tricuspid valvuloplasty and VSD closure. The use of tranexamic acid and transfusion of fresh whole blood appears to produce beneficial effects for outcome. (Korean J Anesthesiol 2009;56:578~82)
증례보고 : 가열호흡회로 내 증류수로 인한 열/습도 교환기 폐쇄 일례
정채인 ( Chae In Jeong ),이상일 ( Sang Il Lee ),안여현 ( Yeo Hyun Ahn ),김지연 ( Ji Yeon Kim ),김경태 ( Kyung Tae Kim ),박장수 ( Jang Su Park ),김정원 ( Jung Won Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Heat-moisture exchanger (HME) is an inexpensive and effective device used to prevent respiratory complications that can be caused by endotracheal tube insertion during general anesthesia. But, HME can increase airway resistance and be occluded by the patient`s secretions. Whether a HME could be occluded by clear fluids such as condensate in the airway circuit is not certain yet. In vitro, a case of HME occlusion by normal saline was reported. We report a case of HME obstruction by distilled water came from the heated wire circuit which was unintentionally connected to the HME. (Korean J Anesthesiol 2009;57:358∼60)