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임상연구 : 간이식 공여자의 수술 후 PT 연장을 예상할 수 있는 인자
허인영 ( In Young Huh ),박순은 ( Soon Eun Park ),조영우 ( Young Woo Cho ),신철호 ( Chul Ho Shin ),백인엽 ( In Yeep Baek ),박세훈 ( Se Hun Park ),황규삼 ( Gyu Sam Hwang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: The increasing shortage of liver donors has resulted in exponential growth of living donor liver transplantation (LDLT). There are obvious concerns about the increased risk to the donors. There has been study on the impact of donation as a function of the degree of resection. However, the effect of inhaled anesthetics combined with the degree of parenchymal loss on the liver function has not been quantified. We analyzed the prothrombin time (PT), as hepatic synthetic function, after donor hepatectomy (DH) with the recipient undergoing general anesthesia with different types of inhaled anesthetics. Methods: One-hundred thirty-four patients who underwent DH were enrolled. The patients were randomly divided into four groups: enflurane (group E), isoflurane (group I), sevoflurane (group S), and desflurane (group D). Anesthesia was performed according to institutional standards. The PT was measured for 7 days before and daily after DH (POD). Total liver volume and resected liver volume were measured and fraction of the graft volume was calculated. Results: The PT peaked on POD 1 in all groups. A significantly lower PT was observed in group D compared to the other groups until POD 3. The fraction of the graft volume showed significant correlation with the PT change. PT abnormalities were affected by the preoperative PT, the graft fraction and inhaled anesthetics. Conclusions: Desflurane induced lesser elevation of the PT than did the other inhaled anesthetics until POD 3. The preoperative PT, the graft fraction and the inhaled anesthetics may be key factors for inducing postoperative PT abnormalities. (Korean J Anesthesiol 2006; 51: 680~4)
임상연구 : 개흉술 후 경막외 자가통증 조절 시 진토제의 효과 비교
허인영 ( In Young Huh ),천무영 ( Moo Young Cheon ),최인철 ( In Cheol Choi ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: Patient controlled analgesia (PCA) has become an important means for treating postoperative pain. However, postoperative nausea and vomiting (PONV) are a major problem for patient using PCA system. This study was designed to evaluate the efficacy of two prophylactic antiemetic regimens on PONV during PCA after lobectomy. Methods: Sixty five patients, who underwent lobectomy and received a mixture of 0.18% ropivacaine at 0.5μg/kg/hr of fentanyl (2,000μg) via thoracic epidural catheter. The study design was a prospective, randomized, double-blinded, placebo-controlled study. Group C was saline control group. In Group A or B, Nasea(R) (ramosetron) or Zofran(R) (ondansetron) was administered as an intravenous bolus at completion of operation. We assessed the frequency and severity of PONV at 6, 24, 48 hours after anesthesia. Postoperative pain was assessed 6 hr after the operation and everyday for 6 days on visual analog scale (VAS). Postoperative side effects and patient satisfaction for epidural analgesia were assessed by 4 grades. Results: PONV occurred in 20%, 20%, and 35% of patients in Group A, B, and C at 6 hr after anesthesia, and 12%, 30%, and 30% at 24 hr after anesthesia. There were no significantly statistical differences among three groups. The VAS scores during coughing were higher than those of resting state without intergroup difference. There were no serious clinical adverse events caused by the study drug and epidurally administered drugs in any study groups. Conclusions: This study found that ramosetron and ondansetron for preventing PONV during epidural PCA after lobectomy was not different from placebo control. (Korean J Anesthesiol 2006; 51: 70~5)
임상연구 : 술 전 신기능 이상이 간이식술 시 주술기 신기능의 변화 및 임상 변수에 미치는 영향
허인영 ( In Young Huh ),박순은 ( Soon Eun Park ),강건 ( Keon Kang ),조영우 ( Young Woo Cho ),신철호 ( Chul Ho Shin ),황규삼 ( Gyu Sam Hwang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: Liver transplantation (LT) has become the treatment of choice for advanced liver disease. However, renal dysfunction often complicates the course of liver transplant recipients. The preoperative serum creatinine level have been shown to be an important predictor of a short-term graft and patient survival rates and the need for perioperative dialysis. This study examined the impact of the pretransplant renal function on the anesthetic characteristics and renal function after LT. Methods: Patients undergoing LT were divided two groups according to the creatinine (Cr) level at time of LT. The following information was collected for each patient: age, etiology, weight and height, serum Cr, Cr clearance, patient survival, and cause of death. The laboratory data was collected at preoperative day, operation day and postoperative 1, 7, 30 days and 6 months. The hemodynamic profile was collected during LT. Results: There were 27 patients in the renal dysfunction (RD) group. Ascites, total blood transfusion and fluid administration was significantly higher in the RD group. The hemodynamic parameters were similar in both groups. The BUN and Cr levels were significantly higher in the RD group in the perioperative period. At the preoperative period, the AST, ALT, bilirubin and prothrombin time was significantly higher in the RD group. The postoperative ICU stay and mortality rate was higher in the RD group. Conclusions: A pretransplant renal dysfunction is the result of deterioration in the liver function in the preoperative period, and indicates a greater requirement of blood and fluid during surgery. (Korean J Anesthesiol 2006; 51: 584~90)
허인영 ( In Young Huh ),최규택 ( Kyu Taek Choi ),천무영 ( Moo Young Cheon ),박평환 ( Pyung Hwan Park ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Cyanosis in children is most often caused by pulmonary disease, or cyanotic heart disease but is rarely caused by hematological problems such as methemoglobinemia and sulfhemoglobinemia. Abnormal hemoglobins with a reduced oxygen affinity are an exceptionally uncommon cause of cyanosis in children. Hemoglobin-M (Hb-M) is rapidly auto-oxidized into the met-form resulting in the loss of its O2-binding ability. This hemoglobinopathy is inherited in an autosomal dominant pattern and is characterized by marked cyanosis. Hb-M affects the anesthetic management because of the anomalous absorption spectrum of Hb-M in standard pulse oximetry. Sufficient O2 delivery should be maintained by keeping a high FiO2 and intermittently checking the O2 delivery state using arterial blood gas analysis. We reported our experience of the anesthetic management of a patient with hemoglobin M. (Korean J Anesthesiol 2006; 50: 723~6)
임상연구 : Ketamine 마취유도가 압반사의 심박수 조절에 미치는 영향
송준걸 ( Jun Gol Song ),신원정 ( Won Jung Shin ),전인구 ( In Gu Jun ),강수진 ( Su Jin Kang ),최병문 ( Byung Moon Choi ),윤미옥 ( Mi Ok Youn ),김태희 ( Tae Hee Kim ),김영국 ( Young Kug Kim ),허인영 ( In Young Huh ),강성식 ( Seong S 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: It is reported that ketamine increases central sympathetic activity as well as catecholamine reuptake inhibition. However, little has been known about baroreflex control of heart rate in ketamine anesthetized humans. Thus, the aim of this study was to analyze the effect of ketamine on spontaneous baroreflex sensitivity (BRS) during ketamine induction of anesthesia. Methods: Beat-by-beat arterial blood pressure and electrocardiogram at 5 min before and 10 min after ketamine administration (2 mg/kg) were recorded in twenty healthy living liver transplant donors. Spontaneous BRS was assessed by sequence method and transfer function analysis method. Results: Spontaneous BRS assessed by sequence method, BRSsequence, decreased from 13.7 ± 6.3 to 7.8 ± 4.5 ms/mmHg (P < 0.001). Spontaneous BRS assessed by low frequency transfer function method decreased from 10.9 ± 5.4 to 7.0 ± 4.1 ms/mmHg and by high frequency transfer function method from 14.8 ± 9.2 to 8.7 ± 8.8 ms/mmHg, respectively (P < 0.05). Conclusions: The spontaneous BRS was decreased during ketamine induction of general anesthesia. These results suggest that anesthesia induction with ketamine impairs baroreflex control of heart rate, which may provoke hemodynamic instability. (Korean J Anesthesiol 2006; 51: 528~34)
허인영,윤명하 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.4
Background: Severity of aspiration pneumonitis is associated with acidity and volume of aspirated gastric contents. Volume and acidity of gastric contents are influenced by food, drugs, and patient factors. However, most studies were performed without controlling these factors. The objectives of this study were to determine the effects of a 20 mg intravenous famotidine injection on gastric content volume and acidity. 1 to 2 hours prior to general anesthesia after controlling the last intake of food. Methods: One hundred twenty three healthy patients were randomly assigned to famotidine and control groups. All patients were requested to drink 200 ml of milk the night before surgery in order to control food related factors and fasting time. After induction of general anesthesia, volume and acidity of aspirated gastric contents were measured. Results: There were no significant differences in acidity of aspirated gastric contents between the two groups. However, the famotidine group showed a significant aspirated gastric volume reduction compared with that of the control group. Conclusions: Famotidine premedication by intravenous injection 1 to 2 hours prior to general anesthesia may be effective to prevent aspiration pneumonitis by reducing gastric content volume. (Korean J Anesthesiol 2001; 40: 443 ~447)
허인영,이정락,임여정,임정길,양홍석 대한정맥마취학회 2001 정맥마취 Vol.5 No.3
Patients with limb abnormalites may present challenges for anesthesiologist because of difficulty with venous acess, placement of standard monitors. Amelia, defined as the complete absence of a limb, is generally thought to be sporadic anomaly. It can present as an isolated defect or associated malformations. Teratogens such as thalidomide and alcohol, vascular compromise by amniotic band, matemal diabetes have been reported to cause this severe limb deficiency. It is important for physicians to develop stratiegies for the care of these patients as they mature and require medical attention. The following case report describes the anesthetic management of a patient with tetra-amelia requiring posterior correction of thoracic scoliosis.