Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index

소사라,박진하,김정민,이민정,고신옥,백효채,박무석,나성원 대한중환자의학회 2014 Acute and Critical Care Vol.29 No.4

Background: Weaning from mechanical ventilation is difficult in the intensive care unit (ICU). Many controversial questions remain unanswered concerning the predictors of weaning failure. This study investigates patient characteristics and delayed weaning after lung transplantation. Methods: This study retrospectively reviewed the medical records of 17 lung transplantation patients from October 2012 to December 2013. Patients able to be weaned from mechanical ventilation within 8 days after surgery were assigned to an early group (n = 9), and the rest of the patients were assigned to the delayed group (n=8). Patients’ intraoperative and postoperative characteristics were collected and analyzed, and conventional weaning predictors, including rapid shallow breathing index (RSBI), were also assessed. Results: The results of the early group showed a significantly shorter ICU stay in addition to a shorter hospitalization overall. Notably, the early group had a higher body mass index (BMI) than the delayed group (20.7 vs. 16.9, p = 0.004). In addition, reopening occurred more frequently in the delayed group (1/9 vs. 5/8, p = 0.05). During spontaneous breathing trials, tidal volume (TV) and arterial oxygen tension were significantly higher in the early group compared to the delayed weaning group, but differences in RSBI and respiratory rate (RR) between groups were not statistically significant. Conclusions: Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.

Sex Differences in Remifentanil Requirements for Preventing Cough during Anesthetic Emergence

소사라,이정림,박윤곤,강상욱,이보라 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3

Purpose: Target-controlled infusion (TCI) of remifentanil can suppress coughing during emergence from general anesthesia; nevertheless, previous studies under different clinical conditions recommend significantly different effective effect-site concentrations (effective Ce) of remifentanil for 50% of patients (EC50). The differencesamong these studies include type of surgery and patient sex. In recent years, study of sex differences in regards to anesthetic pharmacology has drawn greater interest. Accordingly, we attempted to determine the effective Ce of remifentanilfor preventing cough for each sex under the same clinical conditions. Materialsand Methods: Twenty female and 25 male ASA physical status I-II grade patients between the ages of 20 and 46 years who were undergoing thyroidectomy were enrolled in this study. The effective Ce of remifentanil for preventing cough was determined for each sex using the isotonic regression method with a bootstrappingapproach, following Dixon’s up-and-down method. Results: Isotonic regressionwith a bootstrapping approach revealed that the estimated EC50 of remifentanilfor preventing coughing during emergence was significantly lower in females {1.30 ng/mL [83% confidence interval (CI), 1.20-1.47 ng/mL]} than in males [2.57 ng/mL (83% CI, 2.45-2.70 ng/mL)]. Mean EC50 in females was also significantly lower than in males (1.23±0.21 ng/mL vs. 2.43±0.21 ng/mL, p<0.001). Mean arterial pressure, heart rate, and respiratory rate over time were not significantly different between the sexes. Conclusion: When using remifentanilTCI for cough prevention during anesthetic emergence, patient sex should be a considered for appropriate dosing.

Anesthetic-induced myocardial protection in cardiac surgery: relevant mechanisms and clinical translation

소사라,송종욱,최낙철,심재광 대한마취통증의학회 2018 Anesthesia and pain medicine Vol.13 No.1

Cardiac surgery is still associated with complications such as adverse perioperative cardiovascular events. Over the past two decades, many studies have shown that volatile anesthetics and opioids provide myocardial protection against ischemia-reperfusion injury in a similar manner as ischemic conditioning. First (1–2 hours) and second (24–72 hours) windows of protection are provided, the underlying mechanisms for which involve activation of G-protein-coupled receptors, protein kinases, and the opening of adenosine triphosphate-sensitive potassium channels. These processes ultimately result in inhibition of the mitochondrial permeability transition pore. Post-conditioning can also be effective when treatment is applied in the proximity of reperfusion. Although propofol lacks these conditioning effects, it acts as a strong antioxidant and protects the myocardium by attenuating oxidative stress related to reperfusion injury. Clinical evidence favors the use of volatile anesthetics over propofol in terms of reduced cardiac enzyme release, length of hospital stay, and mortality. However, the existing evidence level is insufficient to draw a definite conclusion regarding the mortality benefit of one anesthetic over the others. In addition, many common clinical conditions, such as advanced age, hyperglycemia/ diabetes, and hypertrophy, have been shown to mitigate the protective efficacy of the anesthetics, although this effect also lacks clinical validation. Propofol may also abolish the protective effects of volatile anesthetics and opioids by scavenging reactive oxygen species, an essential trigger for pre-conditioning. The following review addresses these issues from a clinical perspective.

公營問題の論據と使用料に對する一考察

小寺一郞 府邑面雜誌社 1931 府邑面雜誌 Vol.1 No.7

지역사회 개발의 실적과 전망 - 우리는 이렇게 일했다 수도서울과 항도 인천을 잇는 가교

소사읍 대한지방행정공제회 1971 地方行政 Vol.20 No.211

N/A

職業科實施經營案

京畿道·素砂公立普通學校 朝鮮敎育會 1933 文敎の朝鮮 Vol.- No.98

Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations

김관섭,송종욱,소사라,곽영란,심재광 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.2

Indications of non-vitamin K antagonist oral anticoagulants (NOACs), consisting of two types: direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitor (rivaroxaban, apixaban, and edoxaban), have expanded over the last few years. Accordingly, increasing number of patients presenting for surgery are being exposed to NOACs, despite the fact that NOACs are inevitably related to increased perioperative bleeding risk. This review article contains recent clinical evidence-based up-to-date recommendations to help set up a multidisciplinary management strategy to provide a safe perioperative milieu for patients receiving NOACs. In brief, despite the paucity of related clinical evidence, several key recommendations can be drawn based on the emerging clinical evidence, expert consensus, and predictable pharmacological properties of NOACs. In elective surgeries, it seems safe to perform high-bleeding risk surgeries 2 days after cessation of NOAC, regardless of the type of NOAC. Neuraxial anesthesia should be performed 3 days after cessation of NOACs. In both instances, dabigatran needs to be discontinued for an additional 1 or 2 days, depending on the decrease in renal function. NOACs do not require a preoperative heparin bridge therapy. Emergent or urgent surgeries should preferably be delayed for at least 12 h from the last NOAC intake (better if > 24 h). If surgery cannot be delayed, consider using specific reversal agents, which are idarucizumab for dabigatran and andexanet alfa for rivaroxaban, apixaban, and edoxaban. If these specific reversal agents are not available, consider using prothrombin complex concentrates.

다발 골수종 환자에서 발생한 우심방의 유동적 혈전에 의한 급성 폐동맥색전증 -증례 보고-

조윤이,최용선,소사라,고신옥 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.1

Although venous thrombosis is one of the most frequent complications of malignant disease including multiple myeloma, massive pulmonary embolism is an uncommon complication. Free-floating intracardiac thrombus has been rarely reported as a cause of acute pulmonary embolism in patients with multiple myeloma. We report a case presenting acute pulmonary embolism due to free-floating right atrial thrombus in a patient with multiple myeloma.

중국 제3자 모바일 결제시장에서 후발주자의 추격 성공 요인 분석 — 위챗페이의 오락성을 중심으로

오철,노수연,소사한 고려대학교 중국학연구소 2019 中國學論叢 Vol.0 No.63

China’s third-party mobile payment market is expected to grow at average of over 38% until 2019, following the establishment of Alipay in 2004. Wechat Payment has grown rapidly since 2013 as a latecomer, and has formed a duopoly market structure with Alipay. We analyzed common factors and individual factors that influence the behavioral intention and use behavior of Alipay and Wechat Payment through the modified UTAUT model. We found that usability, ease of acceptance, and ease of use play an important role in the behavioral intention of third party mobile payment service. In particular, hedonic motivation is the key factor behind the rapid growth of Wechat Payment. Tencent exploited ‘sociability’ by combining Wechat Payment with Wichat’s main interface, China’s most popular social networking service (SNS) and targeted a niche market such as financial transactions or free remittances between acquaintances. Most importantly, it held the interesting Red Packet events every year since 2014. As consumers will want to consume more pleasure and amusement in the future, it is necessary to build infrastructures that emphasize amusement aspects in financial services like Wechat Payment.

Percutaneous cardiopulmonary support to treat suspected venous air embolism with cardiac arrest during open eye surgery

신서경,남보경,소사라,구본녀 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.5

We report a case of possible venous air embolism (VAE) during trans pars plana vitrectomy with air-fluid exchange ofthe vitreous cavity. Shortly after initiation of air-fluid exchange, decreases in end-tidal CO2, oxygen saturation, and bloodpressure were observed. The patient rapidly progressed to cardiac arrest unresponsive to cardiopulmonary resuscitation,and recovered after the application of percutaneous cardiopulmonary support. Prompt termination of air infusionis needed when VAE is suspected during air-fluid exchange, and extracorporeal life support should be considered infatal cases. Although the incidence is rare the possibility of VAE during ophthalmic surgery clearly exists, and thereforeawareness and vigilant monitoring seem critical.