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임상연구 : 심박출량 측정 시 경식도초음파도플러(Hemosonic 100TM)와 열희석법의 비교
옥시영 ( Si Young Ok ),박현준 ( Hyun Jun Park ),김순임 ( Soon Im Kim ),김선종 ( Sun Chong Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: The measurement of cardiac output (CO) is an important part of anesthetic practice in patients undergoing major surgery. The thermodilution method (TDM), using a pulmonary artery catheter, is still accepted as the standard procedure. However, the use of the method is associated with several limitations and severe complications. The use of a transesophageal Doppler ultrasound monitor (EDUM; Hemosonic 100TM) is less invasive and calculates CO from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. The aim of this study was to compare the cardiac output measured by the use of the TDM and an EDUM. Methods:In 20 patients undergoing major abdominal surgery, CO and other hemodynamic profiles were measured simultaneously by the use of the TDM and an EDUM. Results: The cardiac output, cardiac index, and the systemic vascular resistance monitored by both devices were highly correlated (correlation coefficients range from 0.63 to 0.88). Bland and Altman analysis showed a consistently negative mean bias for an EDUM and the TDM. This finding indicates an overestimation of the hemodynamic profile by the use of an EDUM. Conclusions: Although Bland and Altman analysis showed a significant bias, the use of an EDUM results in cardiac output, cardiac index, and total systemic vascular resistance measurements that are considerably similar to those obtained using the TDM, and a strong correlation exists for the use of the two methods. (Korean J Anesthesiol 2007; 53: 689∼94)
경막외강 확인법으로서 Drip infusion법의 유용성
옥시영 ( Si Young Ok ),유승화 ( Seung Hwa Ryoo ),백영희 ( Young Hee Baek ),김상호 ( Sang Ho Kim ),김순임 ( Soon Im Kim ),김선종 ( Sun Chong Kim ),박욱 ( Wook Park ),송단 ( Dan Song ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2
Background: Cervical epidural anesthesia (CEA) is used for pain control and surgical procedures of the head and neck or upper arm areas. However, the failure rate of CEA is reported to be high, is the failure rate being quite higher than other sites, because of the anatomical differences of the cervical spine. We hypothesized that the loss of resistance (LOR) method combined with the drip infusion method for confirmation of the cervical epidural space can reduce the failure rate. This study investigated the usefulness of the drip infusion method. Methods: One hundred chronic renal failure patients undergoing arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. In the cervical epidural puncture, we identified the cervical epidural space using a combination of the LOR method with the drip infusion method. After confirmation of the epidural space with LOR method, we decided it was the true epidural space when fluid dripping to the space was present. Otherwise, if fluid dripping was not present, we designated it was pseudo LOR, and we found the true epidural space using the drip infusion method only. Results: In all cases, the combined LOR with drip infusion method, identify the epidural space. Conclusions: Combined LOR with drip infusion method is an efficacious method for the confirmation of the cervical epidural space. (Korean J Anesthesiol 2009;57:181∼4)
옥시영 ( Si Young Ok ),배상철 ( Sang Chul Bae ),김혜하 ( Hye Ha Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
A Swan-Ganz catheter is a useful monitoring device for measuring the pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications, including dysrhythmias, pulmonary artery rupture, thrombosis and infection. We report here on a case of malposition of a Swan-Ganz catheter in a 49-year-old female patient who had undergone liver transplantation due to alcoholic liver cirrhosis. (Korean J Anesthesiol 2006; 51: 476~9)
옥시영 ( Si Young Ok ),박성원 ( Sung Won Park ),김순임 ( Soon Im Kim ),김선종 ( Sun Chong Kim ),이민혁 ( Min Hyuk Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Background: Segmental thoracic epidural anesthesia (sTEA) is commonly used for postoperative pain control in chest or upper abdominal surgery. But it is not commonly used for the purpose of pure regional anesthesia. Therefore we investigated the usefulness of sTEA for mastectomy and evaluated the effects of sTEA on respiration and hemodynamics. Methods: Twenty patients scheduled for mastectomy were randomly assigned. Under sitting position, epidural catheter was inserted at T3-4 or T4-5. 20 ml of 0.375% ropivacaine with fentanyl 50μg was injected to maintain anesthesia. The targeted sensory anesthetic dermatomal levels were determined by pinprick and measured at 5 min intervals for the first 15 min after injection of the drugs. If sensory block was not adequate, subsequent 5 ml doses of ropivacaine was injected. Supplemental oxygen (3-6 L/min) was administered through a face mask. After dermatomal level was checked, propofol infusion for sedation was started. Arterial blood sampling was taken for ABGA. Results: Average sensory anesthetic dermatomal levels is C5.5 ± 1.9 - T8.9 ± 2.7. During surgery, hypotension was noted in 25% of patients. It was treated with ephedrine 6 mg i.v. Average PaCO2 is 47.9 ± 7.7 mmHg. Conclusions: Above results suggest that sTEA is suitable for mastectomy as a method of regional anesthesia. (Korean J Anesthesiol 2006; 50: 646~9)