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임상연구 : 두부 하강, 외회전 자세에서의 내경정맥과 경동맥의 관찰
정익수 ( Ik Soo Chung ),권민아 ( Min A Kwon ),황희윤 ( Hee Youn Hwang ),박정헌 ( Jeong Heon Park ),여진석 ( Jin Seok Yeo ),김정수 ( Chung Su Kim ),함태수 ( Tae Soo Hahm ),이상민 ( Sang Min Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: This study evaluated the position and relationship between the right internal jugular vein (IJV) and the surrounding external landmarks using ultrasonography. Methods: Fifty-four patients undergoing central vein access for cardiac surgery were enrolled in this study. The IJV, carotid artery (CA) and sternocleidomastoid muscle (SCM) at the cricoid cartilage level in 15˚ trendelenburg position with 30˚ head rotation were examined using a two dimensional ultrasound transducer of a TEE machine. Images of the vessels and the demographic data of the patients were recorded and analysed. Results: At the level of the cricoid cartilage, the position of the right IJV was medial to middle of the clavicular head of the SCM muscle in 26 cases (48.2%), lateral in 11 cases (20.4%) and just above the middle of clavicular head of the SCM muscle in 17 cases (31.5%). In 43 patients (79.6%), the IJV overlapped the CA anterolaterlly < 5 mm, and these cases were regarded as normal. Ten patients (18.5%) had a medially positioned IJV overlapping the CA more than 5 mm and the IJV was positioned lateral to CA in 1 (2%) patient. The mean ratio of the overlapped diameter and the diameter of the CA was 33.6% and the overlapping ratios were greater than 50% in 10 patients (31.4%). The mean skin-to-vein distance at the angle of 30˚ was 1.82 cm. Conclusions: In 18.5% of patients positioned in the 15˚ Trendelenburg position, with their head turned to the left 30˚, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique. (Korean J Anesthesiol 2006; 51: 11~6)
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)
Ketorolac의 지속적 정주가 Morphine 정맥 PCA 에 미치는 효과
최덕환(Duck Hwan Choi),정익수(Ik Soo Chung),김승오 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2
N/A Background: Ketorolac(Tarasyn®) is a non-steroidal anti-inflammatory drug(NSAID) which has shown to be an effective postoperative analgesic available parenterally, and when combined with morphine can reduce its requirement. The analgesic efficacy and adverse effects of continuous infusion of ketorolac added to morphine IV PCA was evaluated in 60 women after abdominal hysterectomy. Methods: Patients were assigned to receive either morphine intravenous(IV) bolus followed by morphine IV patient controlled analgesia(PCA), or ketorolac 30mg IV and continuous IV infusion at 4.0mg/hr in combination with the above regimen. The authors evaluated PCA morphine used, pain assessment(verbal pain intensity score and visual analogue scale) and side effects at 2, 4, 6 and 24hrs during pain control. Results: Continuous infusion of ketomlac decreased the PCA morphine usage significantly(30.4 -> 19.6 mg: p 0.007) at 24hrs postoperatively. Significant differences were seen favoring ketorolac infusion in pain intensity and visual analogue scale both at rest and during inovement. There were no differences in incidences of deep sedation, nausea & vomiting. But the ketorolac group they complained of dizziness more than morphine only group. Little pruritus was recorded in either groups. Conclusions: The authors conclude continuous IV infusion of ketorolac in conjunction with morphine PCA provide effective analgesia after low abdominal surgery.
노인 뇌동맥류 환자에서 혈관내 치료와 개두술 시 수술방법에 따른 합병증의 비교
김건희 ( Gunn Hee Kim ),정양훈 ( Yang Hoon Chung ),김명희 ( Myung Hee Kim ),정익수 ( Ik Soo Chung ),이정진 ( Jeong Jin Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4
Background: The aim of this study was to compare intraoperative and postoperative complications and clinical outcome of endovascular coiling (EVT) with neurosurgical clipping (NST) under general anesthesia in the cerebral aneurysm patients older than 60 years. Methods: We retrospectively reviewed the charts, operative reports of patients who underwent EVT or NST at our hospital between January 2006 and August 2008. A total of 181 patients (EVT=78, NST=103) were included in this study. Results: The rate of intraoperative event was higher in EVT than in NST but postoperative complication and Glasgow outcome scale (GOS) at 6 months did not show statically significance in both groups. Preoperative aneurysm rupture, age and the World Federation of Neurological Surgeons grade (WFNS) were the influencing factors for outcome in both groups. Anesthetic agents, body temperature and vasoactive drugs were significantly different between the two groups but the effects of these on the outcome of patients were insignificant. Conclusions: In EVT and NST, the variables related to the postoperative complications were preoperative aneurysm rupture, age and WFNS. When the elderly patients get these procedures, more close care should be considered postoperatively. (Korean J Anesthesiol 2009;57:460∼5)