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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)
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)
Propofol/Rocuronium을 이용한 신속 기관 내 삽관 시 Remifentanil의 세 가지 지속 정주 용량에서의 혈역학적 반응
곽미숙 ( Mi Sook Gwak ),최수주 ( Soo Joo Choi ),윤진선 ( Jin Sun Yoon ),이준용 ( Jun Yong Lee ),양미경 ( Mi Kyung Yang ),김갑수 ( Gaab Soo Kim ),이상민 ( Sang Min Lee ),김명희 ( Myung Hee Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: This study compared the effect of the three different infusion doses of remifentanil on the hemodynamic response to rapid sequence anesthesia induction and tracheal intubation. Methods: In this prospective, randomized double-blind study, 60 ASA I or II patients without any airway abnormalities, who were scheduled to undergo elective surgery requiring endotracheal intubation, were allocated to receive remifentanil 0.25, 0.5, or 1.0μg/kg/min. Anesthesia was induced with a remifentanil infusion and propofol 2.0 mg/kg. Rocuronium 1.0 mg/kg was given after a loss of consciousness and endotracheal intubation was performed 1 min after the rocuronium injection. The remifentanil infusion was stopped immediately before intubation. The noninvasive blood pressure (BP) and heart rate (HR) were recorded before induction (baseline), immediately before intubation, and at 1 min intervals until 5 min after intubation. Results: The HR and BP measured immediately before intubation decreased significantly in the three doses. The HR was similar in the three doses, and the BP was significantly different only between the 0.25 and 1.0μg/kg/min doses (P < 0.05). The hemodynamic response to endotracheal intubation was very well blunted in 0.5 and 1.0μg/kg/min, but not in 0.25μg/kg/min. The HR and BP increased significantly 1 min after intubation in the 0.25μg/kg/min (P < 0.05). There were no significant differences between the 0.5 and 1.0μg/kg/min doses until 5 min after intubation. Conclusions: Remifentanil 0.5μg/kg/min infusion without a bolus provides excellent hemodynamic stability for a rapid sequence endotracheal intubation using propofol and rocuronium. There are no advantages in using remifentanil doses higher than 0.5μg/ kg/min. (Korean J Anesthesiol 2006; 50: 385~9)
임상연구 : 유리체망막수술 환자에서 고농도 산소 투여가 수술 후 오심과 구토 발생에 미치는 영향
이애령 ( Ae Ryoung Lee ),최수주 ( Soo Joo Choi ),정해근 ( Hae Keun Jung ),강진구 ( Jin Gu Kang ),곽미숙 ( Mi Sook Gwak ),양미경 ( Mi Kyung Yang ),이상민 ( Sang Min Lee ),김명희 ( Myung Hee Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
Background: Most recently, the antiemetic effects of high inspired oxygen have been discussed and various results have been reported according to the types of surgeries and the groups of patients. In ophthalmic surgical patients, surgical procedures involving intraoperative manipulation of the eye and giving rise to residual eye discomfort were associated with the increased incidences of postoperative nausea and vomiting (PONV). The antiemetic effect of 80% inspired oxygen for the patients undergoing vitreoretinal surgery is unknown. Therefore, we examined the efficacy of 80% inspired oxygen in the decrease of the PONV incidences after vitreoretinal surgery under general anesthesia. Methods: 170 adults under 70 years of age have received standardized sevoflurane anesthesia. After tracheal intubation, they were randomly assigned to two groups: 30% inspired oxygen in air (Group 30), and 80% inspired oxygen in air (Group 80). Postoperative nausea and vomiting were evaluated at the 2, 6, and 24 h postoperatively by an investigator unaware of patients` allocation. Results: There was a significantly lower incidence of PONV during the first 2 h postoperatively in the Group 80 (22%) compared with the Group 30 (40%) (P = 0.024). The Group 80 (33.8%) showed the decreased incidence of PONV during the first 24 h postoperatively compared with the Group 30 (48.8%), but these differences were not statistically significant (P = 0.081). Conclusions: The use of 80% inspired oxygen during vitreoretinal surgery reduced the incidence of PONV during the first 2 h postoperatively. (Korean J Anesthesiol 2007; 53: 54~60)
임상연구 : 외래 마취 환자에서 포도당 용액과 하트만 용액의 투여 용량이 마취 회복에 미치는 영향
신영희 ( Young Hee Shin ),안현주 ( Hyun Joo Ahn ),최수주 ( Soo Joo Choi ),이원형 ( Won Hung Lee ),이병달 ( Byung Dal Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: Adequate fluid administration for ambulatory anesthesia has not been widely studied because most patients are healthy and operations are short durations and not invasive. However, long pre-operative nothing per os (NPO) time is known to affect post-operative complications like pain, headache, dizziness, drowsiness, fatigue, nausea, vomiting, thirsty, sore throat, or well-being sensation. And amount of administered fluid or inclusion of dextrose during the operation could exercise great influence on those symptoms. Therefore, we compared four fluid regimens; 5% dextrose water 2 ml/kg (D/W2), 20 ml/kg (D/W20) and Hartmann`s solution 2 ml/kg (H/S2), 20 ml/kg (H/S20) regarding to post-operative complications of ambulatory anesthesia. Methods: One hundred and sixty ambulatory anesthesia patients of ASA 1 or 2 undergoing general anesthesia or monitored anesthesia care were randomly assigned into D/W2, D/W20, H/S2 or H/S20. Each group of patients received 5% dextrose water 2 ml/kg, 20 ml/kg, Hartmann`s solution 2 ml/kg, or 20 ml/kg for 30 min, respectively. Complications like pain, headache, dizziness, drowsiness, fatigue, nausea, vomiting, thirsty, sore throat, or well-being sensation of patients were checked with systemized questionnaire check box graded 4 scales at recovery room, at evening and at 24 hours later. Results: H/S20 group was better in nausea, thirsty and well-being sensation. Sixteen percent of patients showed hypoglycemia before anesthesia. Dextrose water resulted transient hyperglycemia and osmotic diuresis. Conclusions: Large amount of Hartmann`s solution was generally better regarding post-operative complications. We should pay attention at peri-operative hypoglycemia for ambulatory anesthesia. (Korean J Anesthesiol 2007; 52: 55~61)