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나효석,구본욱,심준보,신현정,김덕우,강성범,도상환 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.4
Background: Anesthetic agents used for general anesthesia are emerging possible influential factors for surgical site infection (SSI). In this retrospective study, we evaluated the incidence of SSI after colorectal surgery according to the main anesthetic agents: volatile anesthetics vs. propofol. Methods: A total 1,934 adult patients, who underwent elective colorectal surgery under general anesthesia between January 2011 and December 2013, were surveyed to evaluate the incidence of SSI: 1,519 using volatile anesthetics and 415 using propofol for main anesthetic agents. Patient, surgery, and anesthesia-related factors were investigated from all patients. Propensity-score matching was performed to reduce the risk of confounding and produced 390 patients in each group. Results: Within the propensity-score matched groups, the incidence of SSI was higher in the volatile group compared with the propofol group (10 [2.6%] vs. 2 [0.5%], OR = 5.0 [95% CI = 1.1–22.8]). C-reactive protein was higher in the volatile group than in the propofol group (8.4 ± 5.6 vs. 7.1 ± 5.3 mg/dl, P = 0.001), and postoperative white blood cells count was higher in the volatile group than in the propofol group (9.2 ± 3.2 × 103/μl vs. 8.6 ± 3.4 × 103/μl, P = 0.041). Conclusions: The results of this study suggest that intravenous anesthesia may have beneficial effects for reducing SSI in colorectal surgery compared to volatile anesthesia.
로봇을 이용한 근치적전립선적출술의 마취에 관한 고찰: 근치적치골후전립선적출술과 비교
나효석,김혜영,도상환,전영태,황정원,오아영 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.4
Background: Robotic-assisted radical prostatectomy (RARP) using da VinciⓇ Surgical System is an emerging technique for management of prostate cancer. With retrospective chart review of patients who had RARP or radical retropubic prostatectomy (RRP), we tried to evaluate and compare the effects on the factors related to patients’ outcomes. Methods: We reviewed the data of 144 patients who underwent RARP (group R, n = 76) or RRP (group C, n = 68) under general anesthesia in the same time period retrospectively. The age, anesthesia time, transfusion rate, PACU time, administration of additional analgesics at PACU, admission day after the operation, postoperative complications and intraoperative PaCO2 were examined and compared. Results: Group R showed significantly lower transfusion rate and more rapid discharge after the operation. Intraoperative PaCO2 was increased in process of time in group R. Other variables were not significantly different between the two groups. In group R, mild neuropathy occurred in 2 patients and subcutaneous emphysema occurred in 1 patient. Conclusion: Patients who had RARP needed significantly less transfusion during operation and significantly shorter admission time compared to patients who had RRP.
적외선(赤外線) 체열촬영(體熱撮影)을 이용한 복부구법(腹部灸法)이 복부(腹部) 및 수장(手掌)의 온도에 미치는 영향
나효석,정아롱,정은아,공현우,정경숙,김경혜,Na, Hyo-Sock,Jung, A-Rong,Jung, Eun-A,Kong, Hyun-Woo,Jung, Kyung-Suk,Kim, Kyeong-Hye 대한한방체열의학회 2006 대한한방체열의학회지 Vol.5 No.1
Purpose: The purpose of this study is to report the effects of Abdomial-Moxibustion on abdomen and palm temperature Methods: This study was performed on 42 patients with gastrointestinal trouble, lower abdominal symptoms or hand cold(or hot) hypersensitivity to observe difference in temperature of skin surface between before and after 5 times abdominal-moxibustion using digital infrared themographic imaging(D.I.T.I) Results: After 5 times moxibustion, temperature $difference({\Delta}t)$ on chest. abdomen and palm is reduced each other. Besides the symptoms of patient are alleviated Conclusion: This study showed that abdominal-moxibustion is reducing temperature difference on the body.
뇌동맥류 조기 재출혈을 보인 환자에서 수술 전 두개내압 감소로 인한 국소 신경학적 손상 역전
나효석,박상현,전영태,도상환,김환희,이상철,박희평 대한중환자의학회 2008 Acute and Critical Care Vol.23 No.1
In the first hours after initial hemorrhage, up to 15% of patients with subarachnoid hemorrhage (SAH) due to aneurysmal rupture may have a sudden episode of clinical deterioration resulting from rebleeding. In patients suffering from an aneurismal rebleeding, the prognosis becomes much poor. Early detection of rebleeding and preoperatively appropriate medical treatment for increased intracranial pressure (IICP) might be crucial to decrease the overall mortality and morbidity rate in a patient with aneurismal rebleeding. We report a case of a successful reversal of focal neurological deficit showed in a patient with abrupt rebleeding of ruptured aneurysm whose intracranial pressure was preoperatively reduced with hyperventilation, and thiopental and mannitol administration under general anesthesia in angiography suite, although the patient ended up in death due to postoperative IICP.
나효석,In Ae Song,Hong-Sik Park,Jung-Won Hwang,도상환,Chong Soo Kim 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.6
Background: Dexmedetomidine has a sedative analgesic property without respiratory depression. This study evaluated the efficacy of dexmedetomidine as an appropriate sedative drug for monitored anesthesia care (MAC) in outpatients undergoing cataract surgery on both eyes compared with combination of propofol and alfentanil. Methods: Thirty-one eligible patients were randomly divided into two groups on the first operation day. Dexmedetomidine was administered in group D at 0.6 μg/kg/h, and propofol and alfentanil was infused concomitantly in group P at a rate of 2 mg/kg/h and 20 μg/kg/h, respectively. Sedation was titrated at Ramsay sedation score 3. Iowa satisfaction with anesthesia scale (ISAS) of the patients was evaluated postoperatively. Systolic blood pressure (SBP), heart rate (HR), respiration rate (RR), and peripheral oxygen saturation (SpO2) were recorded throughout the surgery. For the second operation, the group assignments were exchanged. Results: Postoperative ISAS was 50.3 (6.2) in group D and 42.7 (8.7) in group P, which was statistically significant (P <0.001). SBP was significantly lower in group D compared with group P from the beginning of the operation. HR, RR,and SpO2 were comparable between the two groups. There were 8 cases (25.8%) of hypertension in group P, and 1case (3.2%) in group D (P < 0.05). In contrast, 1 case (3.2%) of hypotension and 1 case (3.2%) of bradycardia occurred in group D. Conclusions: Compared with the combined use of propofol and alfentanil, dexmedetomidine could be used appropriately for MAC in cataract surgery with better satisfaction from the patients and a more stable cardiovascular state.
나효석,도상환,김현빈,김종수 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.2
Background: Magnesium sulfate (MgSO4) is the first-line therapy for managing preeclampsia in obstetrics. Its perioperative administration has been proved to be an effective analgesic adjuvant, which we investigated in parturients undergoing Cesarean section (C-sec). Methods: A retrospective chart review examined 504 parturients who underwent C-secs between June 2006 and August 2010,including normal parturients (group N, n = 401) and those diagnosed with preeclampsia (group P, n = 103). A postoperative numeric rating scale (NRS) was used to assess pain, and the number of rescue analgesic administrations and frequency of transfusions were investigated. Perioperative magnesium concentrations were recorded for patients in group P. Results: Patients in group P had longer operation and anesthesia times, and more postoperative admission days than those in group N. The NRS of pain was significantly lower in group P at postoperative day (POD) 1 (4 vs. 5, P < 0.001), and the frequency of rescue drug administration was lower in group P at POD 1 (36.0% vs. 80.3%, P < 0.001) and POD 2 (9.7% vs. 21.1%, P = 0.005) than in group N. Red blood cell transfusions were given more frequently in group P (21.4% vs. 2%, P < 0.001). Pre- and postoperative serum magnesium concentrations in group P were 2.2 (0.5) and 2.1 (0.6) mmol/L, respectively. Conclusions: Postoperative pain after C-sec was less severe and intravenous patient-controlled analgesia was more efficacious in the preeclampsia group than in the non-preeclampsia group. These findings likely resulted from peripartum intravenous MgSO4 administration in the preeclampsia group.
오행화침법(五行和鍼法)을 이용한 임신 중 중둔근 약화 환자 치험 1례
나효석 ( Hyo Sock Na ),백승훈 ( Seung Hun Baek ),박현재 ( Hyun Jae Park ),김경혜 ( Kyeong Hye Kim ),정은아 ( Eun A Jung ) 대한한방부인과학회 2005 大韓韓方婦人科學會誌 Vol.18 No.4
Purpose: The purpose of this study is to report the effect of Hwa-acupuncture for the pain due to weakened gluteus medius muscle during pregnancy Methods: The patient in this case, 35 years-old gravida, was treated at Dongseo oriental medical hospital for thirteen times (09 August 2004 - 26 August 2004) because of the pain due to weakened gluteus medius muscle during pregnancy. This patient was treated with Hwa-acupuncture and physical treatment. Results: After quite short Hwa-acupuncture and physical treatment, the symptoms of patient are remarkable alleviated. Conclusion: We think that many gravida suffered from lumbago and pelycalgia can be managed effectively by Hwa-acupuncture. After this, futher study, approach and case will be needed.
The influence of propofol and sevoflurane on hemostasis: a rotational thromboelastographic study
구본욱,나효석,전영태,황정원,도상환 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.4
Background: Using rotational thromboelastometry (ROTEM)analysis, we investigated the difference in blood hemostasis, basedon the primary anesthetic agents used during general anesthesia. Methods: Sixty-six adult patients scheduled for elective ophthalmicsurgery under general anesthesia were evaluated with regardto changes in each parameter in INTEM, EXTEM, and FIBTEManalyses. The patients received intravenous anesthesia with propofoland remifentanil (TIVA group) or inhalation anesthesia with sevoflurane(SEVO group). The ROTEM tests were performed 10 minbefore starting anesthesia and 1 h after finishing anesthesia. TheINTEM and EXTEM analyses included the clotting time (CT), clotfirmness time (CFT), alpha angle (α), and maximum clot firmness(MCF). The FIBTEM analyzed only MCF. Maximum clot elasticity(MCE) was calculated by (MCF × 100) ÷ (100 − MCF). The plateletcomponent of clot strength was calculated as follows: MCEplatelet =MCEEXTEM − MCEFIBTEM. Results: The preoperative and postoperative parameters (CT,CFT, α, and MCF) in the INTEM, EXTEM, and FIBTEM analyseswere not significantly different between the two groups. TheMCEplatelet also did not show a significant difference. Conclusions: Presuming that the ophthalmic surgery had aminimal traumatic effect, we conclude that both anesthetic agentscause negligible changes in ROTEM analyses postoperatively.