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김창석 ( Chang Seok Kim ),곽영란 ( Young Lan Kwak ),김대희 ( Dae Hee Kim ),라세희 ( Se Hee Na ),심재광 ( Jae Kwang Shim ),방서욱 ( Sou Ouk Bang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: Hydroxyethyl starch (HES) effectively restores plasma volume and thereby enhances microcirculation and tissue oxygenation at the expense of coagulation impairment. These effects are related to molecular weight, substitution and C2:C6 ratio. But, most of the studies regarding coagulation impairment in cardiac surgeries were performed in patients undergoing cardiopulmonary bypass which significantly causes coagulation derangements. Therefore, we have evaluated the effects of 2 different HES solutions on tissue oxygenation and postoperative bleeding in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Methods: Forty four patients were prospectively enrolled. After the induction of anesthesia, either HES 130/0.4 (V group) or 200/0.5 (H group) were infused for fluid therapy to maintain predetermined urine output, cardiac index and filling pressure up to 16 h after the surgery. Tissue oxygenation profiles and respiratory parameters were recorded after induction of anesthesia, completion of distal anastomosis and sternum closure, upon admission at intensive care unit, and 4 h thereafter. The amounts of chest tube drainage, transfusion and fluid balance were measured up to 16 h after the surgery. Results: Patients` demographic data were similar between the groups. Tissue oxygenation profiles, respiratory parameters, hemodynamics, and time to extubate were not different between the groups. However, chest tube drainage and transfusion requirements were significantly less in the V group. Conclusions: In OPCAB, 6% HES 130/0.4 causes less postoperative bleeding and transfusion requirement and has a comparable efficacy on hemodynamic stability, pulmonary function and tissue oxygenation when compared to 6% HES 200/0.5. (Korean J Anesthesiol 2007; 52: 649~56)
임상연구 : 판막수술을 시행 받는 환자에서 레닌-안지오텐신계 길항제가 체외순환 후 요골-대퇴동맥압 간의 차이에 미치는 영향
김대희 ( Dae Hee Kim ),곽영란 ( Young Lan Kwak ),이종화 ( Jong Hwa Lee ),심재광 ( Jae Kwang Shim ),차재호 ( Jae Ho Cha ),방서욱 ( Sou Ouk Bang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: Femoral to radial arterial pressure gradient (△P) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on △P after CPB in patients undergoing valvular heart surgery. Methods: Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure. Results: After CPB, systolic △P was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic △P more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups. Conclusions: Preoperative treatment with RAS-A resulted in clinically significant △P after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery. Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients. (Korean J Anesthesiol 2007; 53: 199~205)
증례보고 : 대동맥판막치환술을 위한 체외순환 이탈 후 경식도심초음파 검사에서 발견된 좌심방귀 내의 혈전
김대희 ( Dae Hee Kim ),곽영란 ( Young Lan Kwak ),심재광 ( Jae Kwang Shim ),오영준 ( Young Jun Oh ),최영림 ( Yeong Rim Choi ),방서욱 ( Sou Ouk Bang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Intraoperative transesophageal echocardiography (TEE) during cardiac surgery is an invaluable procedure, which aids hemodynamic management as well as surgical directions. TEE adds valuable information to the assessment of cardiac structures and in contrast to transthoracic echocardiography (TTE), due to its proximity to left atrium (LA), it is especially useful in detection of mass lesions in the LA. The following case describes a patient undergoing aortic valve replacement under cardiopulmonary bypass with low risk of thrombi formation and undetected thrombi in the LA appendage by preoperative TTE. These thrombi could be detected by intraoperative TEE and removed at the same operation, thus avoiding thromboembolic complication and second operation. (Korean J Anesthesiol 2007; 52: 596~9)