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증례보고 : 제7응고인자 결핍증 수술환자에서 재조합 활성화 제7인자의 임상 경험
김성환 ( Sung Hwan Kim ),임경지 ( Kyung Ji Lim ),윤승주 ( Seung Zhoo Yoon ),박금숙 ( Kum Suk Park ),도상환 ( Sang Hwan Do ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
A 33-yr old female patient with coagulation factor VII deficiency was scheduled for laparoscopic oophorectomy under the diagnosis of ovarian teratoma. Plasma concentration of factor VII of this patient was 9 IU/dl (normal range; 60-140 IU/dl) and the prothrombin time INR (International Normalization Ratio) was 1.79 (normal range; 0.8-1.2) on the day before the operation. Total 1,200μg (30μg/kg) of recombinant activated factor VII (rFVIIa) was administered just before the start of the laparoscopic procedure, which was accomplished safely without severe hemorrhage or other complications. Postoperative course was uneventful. In addition, this article provides the clinical implication of rFVIIa in terms of hemostasis management in hemophiliacs and surgical patients. (Korean J Anesthesiol 2007; 52: 609~11)
증례보고 : 자궁내시경적 근종제거술 동안 발생한 저나트륨혈증
김환희 ( Hwan Hee Kim ),황진영 ( Jin Young Hwang ),전영태 ( Young Tae Jeon ),황정원 ( Jung Won Hwang ),도상환 ( Sang Hwan Do ),나효석 ( Hyo Seok Na ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Hysteroscopy is frequently used to assist the diagnosis and treatment of a series uterine diseases. However, complications associated with the procedure including fluid overload, hyponatremia, hypo-osmolality, hemorrhage, uterine perforation, and air embolism have been reported. The incidence of fluid overload with hyponatremia during hysteroscopic procedures has been reported to be up to 6% and it can probe fatal. Thus, early recognition of this condition and prompt intervention thereof is important to prevent adverse sequelae. Here, we report a case of hyponatremia with incidental fluid overload during hysteroscopy. We detected the signs of complication early on and were thus able to manage it promptly without any resulting adverse sequelae. (Korean J Anesthesiol 2009;57:629∼32)
임경지 ( Kyoung Ji Lim ),박금숙 ( Kum Suk Park ),도상환 ( Sang Hwan Do ),이영선 ( Young Sun Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia. (Korean J Anesthesiol 2007; 53: 262~5)
증례보고 : 주산기 심근병증 산모의 제왕절개술을 위한 척추- 경막외 병용 마취
박희연 ( Hee Yeon Park ),구의경 ( Eui Kyoung Goo ),도상환 ( Sang Hwan Do ),박금숙 ( Kum Suk Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy associated with a significant morbidity and mortality. The anesthetic management of a Cesarean section in patients with PPCM has not been well defined. Herein, our experience of a 31-year-old multipara, with recurrent PPCM and congestive heart failure, who presented for an elective cesarean section, is reported. Combined spinal-epidural anesthesia was successfully employed as the anesthetic technique for the procedure. The intra-arterial blood pressure and central venous pressure were monitored throughout the procedure. In addition, the patient`s postoperative pain was markedly reduced with the use of epidural PCA. Combined spinal-epidural anesthesia is suggested to be a reliable technique, which provides minimal hemodynamic changes, and a lower failure rate than epidural anesthesia only, and is also highly effective with a low dose of local anesthetic drug. (Korean J Anesthesiol 2007; 52: 605~8)
임상연구 : 부인과 수술 후 오심 및 구토의 예방에 대한 Ramosetron과 Ondansetron의 효과 비교
유정희 ( Jung Hee Ryu ),박금숙 ( Kum Suk Park ),도상환 ( Sang Hwan Do ),서정훈 ( Jeong Hun Suh ),강매화 ( Mae Hwa Kang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Background: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) in gynecologic patients. Methods: Sixty patients undergoing total abdominal hysterectomy or myomectomy, ASA physical status I or II, aged 30-65 yr, received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) at the end of surgery (n = 30 each). A standard general inhalational anesthesia and postoperative IV patient-controlled analgesia were used. At postoperative 3, 24 and 48 hours, we assessed pain score (VAS), incidence of PONV, rescue drug consumption, adverse events associated with study medications and overall satisfaction scores. Results: The incidence of PONV showed no difference between groups at each time points after surgery (overall incidence; 59% in group R, 69% in group O). There was no difference in the severity of nausea, pain score and analgesic drug usage. However, the consumption of rescue drug in the ramosetron group was markedly less than that of ondansetron group at postoperative 3 hrs (none vs. 8 patients). No clinically serious adverse events were observed in either of the groups. Overall satisfaction scores were also comparable in both groups (6.5 ± 3.0 vs. 6.2 ± 2.7). Conclusions: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in women undergoing general anesthesia for gynecologic surgery. Severity of PONV seems significantly less with ramosetron than with ondansetron in the early postoperative period. (Korean J Anesthesiol 2007; 52: 561~5)
임상연구 : Propofol-Remifentanil 및 Propofol-Nitrous Oxide를 이용한 전신마취의 비교
서정훈 ( Jeong Hun Suh ),윤정연 ( Jung Yeon Yun ),박금숙 ( Kum Suk Park ),도상환 ( Sang Hwan Do ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
Background: Remifentanil is a novel, ultra-short acting opioid. This study was performed to compare the hemodynamic responses of remifentanil and nitrous oxide under propofol-based anesthesia during the intraoperative period. Methods: Forty patients undergoing gynecologic surgery were randomly allocated to either remifentanil (R group) or N2O group (N group). In the R group, remfentanil was continuously infused from the induction of anesthesia (0.5㎍/kg/min) to the end of surgery (0.1-0.5㎍/kg/min). In the N group, fentany1 (2㎍/kg) was injected intravenously and N2O was used thereafter. In both groups, target-concentration infusion of propofol was applied. We compared mean arterial pressure (MAP) and heart rate (HR) before and after tracheal intubation and during the rest of anesthetic time between the two groups. Postoperative parameters such as nausea/vomiting, consciousness level and pain at 2 and 24 hours were also compared. Results: The magnitude of MAP and HR after tracheal intubation were significantly smaller and more stable in the R group than in the N group. Hypertensive (systolic blood pressure> 140 mmHg) episodes were significantly less frequent in the R group (3.0%) than in the N group (12.4%) during the operation. R group showed less MAP (76 ± 12 mmHg) and HR (61 ± 10 bpm) compared with those of N group (86 ± 17 mmHg, 63 ± 8 bpm, P < 0.05 respectively). Other postoperative measures were comparable between the two groups. Conclusions: We conclude that the continuous infusion of remifentanil can provide more stable hemodynamic status than N2O without significant adverse effects, in propofol-based general anesthesia. (Korean J Anesthesiol 2006; 51: 151~6)