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일차성 인공 고관절 치환술과 재치환술 간의 술 후 폐합병증 발생빈도 및 위험인자의 비교
박상진 ( Sang Jin Park ),정걸 ( Gul Jung ),지대림 ( Dae Lim Jee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Background: Risk factors for postoperative pulmonary complication (PPC) after total hip arthroplasty (THA) are poorly studied. In addition, the risk factors associated with revision THA may differ from those associated with primary THA. The purpose of this study was to compare the incidences of PPC after revision THA with those observed after primary THA, and to evaluate the risk factors. Methods: We reviewed data describing patients who underwent primary (n=410) and revision THA (n=90) during a 10 year study period. The data included age, gender, body mass index, concurrent cardiopulmonary comorbidity, anesthetic techniques, operative time, the number of perioperative transfusions, the amount of fluid replaced, and the American Society of Anesthesiologists physical status. PPCs were grouped together as a single outcome and the incidence and the risk factors for PPC were analyzed. Results: The incidence of PPC after revision THA was significantly higher than after primary THA (23.3% vs. 11.5%, P=0.004). The significant risk factors in revision THA were the amount of fluid replaced ≥3,000 ml (P=0.014) and operative time ≥180 min (P<0.001), while there were no risk factors identified by primary THA during univariate analysis. Furthermore, the only significant risk factor identified by multiple logistic regression analysis was operative time (odds ratio=8.2, P<0.05). Conclusions: Patients undergoing revision THA are at higher risk of PPC than primary THA. The operative time is an important factor in the occurrence of PPC after revision THA. (Korean J Anesthesiol 2009; 57: 50~5)
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김승동,정걸,지대림 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2
A 67-year-o1d woman with severe congestive heart failure (New York Heart Association, NYHA class IV) was set to receive general anesthesia for cardiac surgery. For several months, she had been in a constant sitting position from which the slightest change evoked dyspnea. A Patient in such a condition is rarely considered a candidate for general anesthesia, because such patients are never eligible for any type of surgery other than that used to fix the heart problem itself We report this case to explain how anesthesia was induced with the Patent sitting in a crouching position and discuss other methods of induction that can Probably be used in similar situations.
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