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Intraoperative predictors of early tracheal extubation after living-donor liver transplantation
이세린,사계절,김윤아,박철수 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.2
Background: Prolonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transplantation (LDLT). We investigated specific predictors of early extubation after LDLT. Methods: Perioperative data of adult patients undergoing LDLT were reviewed. “Early” extubation was defined as tracheal extubation in the operating room or intensive care unit (ICU) within 1 h posttransplant, and we divided patients into early extubation (EX) and non-EX groups. Potentially significant (P < 0.10) perioperative variables from univariate analyses were entered into multivariate logistic regression analyses. Individual cut-offs of the predictors were calculated by area under the receiver operating characteristic curve (AUC) analysis. Results: Of 107 patients, 66 (61.7%) were extubated early after LDLT. Patients in the EX group showed shorter stays in the hospital and ICU and lower incidences of reoperation, infection, and vascular thrombosis. Preoperatively, model for end-stage liver disease score, lung disease, hepatic encephalopathy, ascites, and intraoperatively, surgical time, transfusion of packed red blood cell (PRBC), urine output, vasopressors, and last measured serum lactate were associated with early extubation (P < 0.05). After multivariate analysis, only PRBC transfusion of ≤ 7.0 units and last serum lactate of ≤ 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865). Conclusions: Intraoperative serum lactate and blood transfusion were predictors of posttransplant early extubation. Aggressive efforts to ameliorate intraoperative circulatory issues would facilitate successful early extubation after LDLT.
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한성민,문동언,김영훈,박휴정,이민규,사계절 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.4
Pudendal neuralgia is characterized by severe sharp pain along theinnervation area of pudendal nerve, which may be worsened whensitting position. Successful pudendal nerve block is crucial to thediagnosis of pudendal neuralgia. Although fluoroscopy-guided pudendalnerve blocks have traditionally been performed, recentlyultrasound-guided pudendal nerve blocks were reported. For thelong term effect of nerve block, pulsed radiofrequency was performedunder fluoroscopic guidance in some reports. We report oursuccessful experiences of three cases using ultrasound-guidedpulsed radiofrequency.
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