Clinical Research Article : The effect of postoperative pain on postoperative blood Loss after sequential bilateral total knee arthroplasty

( So Yeon Kim ),( Yong Jun An ),( Soo Hwan Kim ),( Ha Kyoung Kim ),( Jeong Soo Park ),( Yang Sik Shin ) 대한마취과학회 2011 Korean Journal of Anesthesiology Vol.60 No.2

Background: Bilateral total knee arthroplasty is generally accompanied by a significant amount of blood loss. We investigated the relationship between the intensity of pain and the amount of blood loss in the early postoperative period after bilateral total knee arthroplasty. Methods: A prospective study was conducted on 91 patients who underwent elective sequential bilateral total knee arthroplasty for osteoarthritis. All patients received combined spinal and epidural anesthesia. Patients were divided into three groups based on their scores on the verbal numerical rating scale (VNRS) for pain at 6 hours postoperatively. The VNRS was classified as follows; mild pain (n=34, VNRS score 0-4), moderate pain (n=24, VNRS score 5-6), and severe pain (n=33, VNRS score 7-10). We compared the mean arterial pressures and the amount of blood loss during the first 24 postoperative hours in the three groups. Factors influencing postoperative blood loss were analyzed. Results: Postoperative mean arterial pressures and blood loss were not different among the groups. Of the factors examined, the amount of postoperative blood loss was only dependent on the amount of intraoperative blood loss (P=0.001). Conclusions: Early postoperative pain has no effect on postoperative blood pressure and the amount of blood loss after bilateral total knee arthroplasty. For postoperative blood loss, intraoperative blood loss is the main determinant. (Korean J Anesthesiol 2011; 60: 98-102)

대퇴 전자간 골절의 금속정을 이용한 내고정술 후 실혈량: 위험 인자 분석

박재형 ( Jai Hyung Park ),정화재 ( Hwa Jae Jung ),신헌규 ( Hun Kyu Shin ),김유진 ( Eugene Kim ),박세진 ( Se Jin Park ),고택수 ( Taeg Su Ko ),박종현 ( Jong Hyon Park ) 대한골절학회 2015 대한골절학회지 Vol.28 No.1

Purpose: We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors. Materials and Methods: A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evansclassification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents. Results: Total calculated blood loss (2,100±1,632 ml) differed significantly from visible blood loss (564±319 ml). In addition, the blood loss of unstable fracture patient was 2,496±1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference. Conclusion: Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.

전립선비대증의 경요도전립선절제술에서 출혈에 영향을 미치는 인자

정연태,류현열,장태호 고신대학교 의학부 2000 高神大學校 醫學部 論文集 Vol.15 No.1

Background Endoscopic resection of the prostate has conferred considerable advantages on patients requiring prostatic surgery. Prostatectomy is probably the most common major urologic operation performed in most hospitals. However, because the patients are elderly and often have a concurrent respiratory or cardiovascular disease, a small but significant mortality and morbidity still exist. This study was performed to evaluate the factors influencing blood loss during transurethral prostatic surgery. Methods All prostatectomies were audited prospectively, recording the pre-and post-operative hemoglobin concentrations, blood transfusions and the variable factors influencing blood loss. The initial statistical test used for the correlations with blood loss was the primary regression equation followed by the Kruskal-Wallis test. Results The peri-operative blood loss, as assessed by various indicators was equivalent to a decrease in humoglobin concentration of 1.2g/㎗. The weight of the resected prostatic tissue was one of the most important factors measured in determining blood loss. The resection time also influenced the blood loss. Other factors did not influence blood loss. The overall transfusion rate was 2% of all patient. Conclusions The cause of blood loss associated with transurethral resection of prostate(TURP) is multifactoral and it is impossible to measure the effect of a single factor while controlling all the others. We suggest that the weight of the resected prostatic tissue is clearly one of the most important factors and that the assessment of this factor helps in anticipating blood loss. Epidural anesthesia is associated with less blood but its advantage is overshadowed in practice by the weight of the resected tissue.

전립선비대증의 경요도전립선절제술에서 출혈에 영향을 미치는 인자

정연태,류현열,장태호 고신대학교(의대) 고신대학교 의과대학 학술지 2000 고신대학교 의과대학 학술지 Vol.15 No.1

Background : Endoscopic resection of the prostate has conferred considerable advantages on patients requiring prostatic surgery. Prostatectomy is probably the most common major urologic operation performed in most hospitals. However, because the patients are elderly and often have a concurrent respiratory or cardiovascular disease, a small but significant mortality and morbidity still exist. This study was performed to evaluate the factors influencing blood loss during transurethral prostatic surgery. Methods : All prostatectomies were audited prospectively, recording the pre- and post-operative hemoglobin concentrations, blood transfusions and the variable factors influencing blood loss. The initial statistical test used for the correlations with blood loss was the primary regression equation followed by the Kruskal-Wallis test. Results : The peri-operative blood loss, as assessed by various indicators, was equivalent to a decrease in hemoglobin concentration of 1.2 g/dl. The weight of the resected prostatic tissue was one of the most important factors measured in determining blood loss. The resection time also influenced the blood loss. Other factors did not influence blood loss. The overall transfusion rate was 2% of all patient. Conclusions : The cause of blood loss associated with transurethral resection of prostate (TURP) is multifactoral and it is impossible to measure the effect of a single factor while controlling all the others. We suggest that the weight of the resected prostatic tissue is clearly one of the most important factors and that the assessment of this factor helps in anticipating blood loss. Epidural anesthesia is associated with less blood loss but its advantage is overshadowed in practice by the weight of the resected tissue.

대퇴골 경부 골절에 대한 양극성 인공 고관절 반치환술에서의 실혈량: 위험 인자 분석

박재형 ( Jai Hyung Park ),김형수 ( Hyoung Soo Kim ),유정현 ( Jeong Hyun Yoo ),김주학 ( Joo Hak Kim ),성기혁 ( Ki Hyuk Sung ),김준엽 ( Joon Yub Kim ),박상준 ( Sang Jun Park ),이인혁 ( In Hyeok Lee ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.2

목적: 고관절 대퇴 경부 골절로 인한 양극성 반 인공 관절 치환술 후 보이지 않는 실혈을 포함한 실질적인 총 실혈량을 계산하여 측정된 실혈량과의 차이를 알아보고 위험 인자가 술 후 실혈량에 미치는 영향을 알아보고자 한다. 대상 및 방법: 2004년부터 2010년까지 본원에서 시행한 대퇴 경부 골절 후 양극성 반 인공관절 치환술을 시행한 환자 356예를 대상으로 하였고 총 실혈량의 계산은 Mercuriali와 Brecher에 의한 공식을 사용하였으며 실혈량에 미치는 위험 인자로 성별, body mass index (BMI), 마취 방법, 심혈관 질환이나 뇌혈관 질환 유무, 술전 빈혈 여부, American Society of Anesthesiologists (ASA) 점수, 시멘트 사용 여부, 항혈전제 사용 여부를 비교 분석하였다. 결과: 계산된 총 실혈량은 1,408±72 ml이고 측정된 실혈량은 980±102 ml로 유의한 차이를 보였고 실혈량과 관련된 위험 인자 중 심혈관 질환이 있을 경우 1,526±369 ml, 전신 마취 시행 시 1,588±279 ml, 비만이 있는 경우 1,645±920 ml, 항혈전제 사용 시 1,605±439 ml로 증가된 결과를 보였다. 결론: 고관절 대퇴 경부 골절 후 양극성 반 인공 관절 치환술시 발생된 총실혈량은 측정된 실혈량에 비해 많은 많은 양이 측정되었으며 수술대상 환자 중 심혈관 질환 및 항혈전제 복용자, 비만 환자, 전신 마취 시에는 수술 시 출혈량을 줄이기 위한 세심한 노력이 필요할 것으로 사료된다. Purpose: We compared visible blood loss and calculated blood loss after bipolar hemiarthroplasty in femoral neck fracture, and evaluated correlation between blood loss and its risk factors. Materials and Methods: A total of 356 patients who underwent bipolar hemiarthroplasty in femoral neck fracture between 2004 and 2010 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score, use of cement, and use of antithrombotic agents. Results: Total calculated blood loss(1,408±72 ml) differed significantly from visible blood loss(980±102 ml). In addition, calculated blood loss differed between risk factors(1,526±369 ml in cardiovascular disease, 1,588±279 ml in general anesthesia, 1,645±920 ml in obesity, and 1,605±439 ml in use of antithrombotic agents). Conclusion: Total calculated blood loss was much greater than visible blood loss. Patients with risk factors such as cardiovascular disease, obesity, use of antithrombotic agents, and general anesthesia should be treated with care in order to reduce blood loss.

중환자에서 동맥혈 가스분석 횟수와 그로인한 실혈량에 대한 연구

이석열,전철우,정영수,오희숙,마분란,이정미,정혜영,이만복,이길노 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Background : Arterial blood gas analysis is the most comon exam in intensive care unit. In this study, the frequency of blood gas analysis and the amount of blood loss after Blood Gas Analysis in Intensive Care Unit were observed. Methods : From November 1999 to February 2000, 115 patients admitted to intensive care unit at Soonchunhyang university Kumi hospital were studied prospectively for the frequency of blood gas analysis and the amount of blood loss after blood gas analysis in Intensive Care Unit. Results : The mean value of frequency of blood gas analysis was 6.41±6.49 and the mean value of amount of blood loss after blood gas analysis was 0.78ml. This was lower than that of other foreign reports. The patients with ventilator therapy above 24 hours showed higher frequency of blood gas analysis than that of not applied ventilator patients. Pulse oxymetry was applied to all patients and the frequency of blood gas analysis was decreased due to the use of strict pulse oxymetry. Conclusion : Doctors and nurses in intensive care unit keep in mind that adequate blood sampling is needed for the decrease of blood loss. Education and protocol for the decrease of blood loss after arterial blood gas analysis may be necessary.

체급경기선수의 체중 감량이 blood cell count, hemoglobin, hematocrit, 혈장량에 미치는 영향

김명수,권영우 한국체육과학회 2024 한국체육과학회지 Vol.33 No.1

This study aims to determine how weight loss in weight class athletes affects blood cell count(red blood cell, white blood cell, white blood cell subset), hemoglobin, hematocrit and plasma volume. Eight weight class athletes were selected for this study. All participants lost 5% of their body weight over a total of 16 days. All variables were measured at rest before and after weight loss. Red blood cell(RBC), hemoglobin and hematocrit, which are related to oxygen carrying capacity, did not show changes due to weight loss. Considering changes in plasma volume, no significant differences were found in such variables. White blood cells and white blood cell sub types such as neutrophils, lympocytes and monocytes related to immune function, tended to decrease overall after weight loss compared to before weight loss, but there was no significant difference. However, when changes in plasma volume were considered, significant differences were found in white blood cells, and lymphocytes. In summary, weight loss in weight class athletes did not appear to cause changes in blood oxygen transport and immune function-related variables. However, when changes in plasma volume were taken into account, a decrease in immune function was found. In order to more clearly identify the effects of weight loss on oxygen transport and immune function in weight class athletes, additional research related to the period of weight loss or the degree of weight loss is also required.

하악지시상분할절단술에서 자가수혈의 이용시 혈액학적변화에 관한 연구

김신헌,윤형기,박진혁,김우형,이희철,Park, Jin-Bae 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Objective : s we has known risk of acquired immunodeficiency disease due to trans-fusion, we recognize the importance of autologous blood transfusion. Since 1990, the use of autologous blood transfusion was increased in Korea. The use of autologous blood transfusion in orthognathic surgery is common. The purpose of this research is to determine, in patients undergoing sagittal split ramus osteotomy, clinical predictive cri??eria for preoperative autologous blood donation and to propose guidelines to increase the efficiency of it. Methods and Material : This article reviewed one hundred two patient who had received bilateral sagittal split ramus osteotomy with autologous blood donation in oral and maxillofacial surgery, Paik hospital, Pusan, from January 1995 to December 1999. Hemoglobin & hematocrit change was evaluated pre- and postoperatively, and erythropoiesis, relationship between procedure time and blood loss was evaluated. Results : 1. Mean age of male patient was 23.1 years and that of female patient 22.5 years. Mean body weight was 73.7㎏ in male and 49.4㎏ in female. 2. Preoperative autologous blood donation unit was mean 1.9 unit(1unit=320㎖), and transfused unit was mean 1.3 unit. 3. Three of 102 patients had positive reaction for hapatitis B virus, but no complication were occurred. 4. The interval from initial donation of autologous blood to surgery was 19 days, and from last donation to surgery was 11 days. 5. Mean hemoglobin levels in predonation period were 15.1 g/㎗ in male and 12.7g/㎗ in female. Hemoglobin and hamatocrit levels decreased by 1.0g/㎗ and 3.2% in male and 1.1g/㎗ and 3.3% in female, respectively, after collection of 1 unit of autologous blood, and decreased by 1.8 g/㎗ and 6.4% in male and 1.9 g/㎗ and 6.9% in female after collection of 2 units. 6. Preoperative erythropoiesis from first donation to surgery showed no statistically significant difference between male and female patients. 7. Estimated blood volume(EBV) ranged from 4,100㎖ to 5,800㎖ in male and from 2,600㎖ to 3,600㎖ in female. Mean estimated blood loss(EBL) was 640㎖, and up to 32% of EBV. 8. All 25 patients with more than 20% loss of EBV were trnasfused intraoperatively, and 18 of 24 patient with 16-20% loss, 16 of 30 patient with l1~15% loss, 7 of 20 patient with less than 10% loss were transfused. Transfusion requirement was increased parallel to EBV. Conclusion : It seems that the proper unit of autologous blood donation is 1.3 unit, and autologous blood transfusion is a safe method in elective surgery that predicted large blood loss. In the future, if transfused blood was controlled based on hypotensive anesthesia, preoperative hemoglobin and hemotocrit level, the proper level of autologous blood transfusion will be accomplished.

A Randomized Controlled Study to Compare the Total and Hidden Blood Loss in Computer-Assisted Surgery and Conventional Surgical Technique of Total Knee Replacement

Amit Singla,Rajesh Malhotra,Vijay Kumar,Chandra Lekha,G. Karthikeyan,Vishwas Malik 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2

Background: Total knee arthroplasty (TKA) is associated with considerable blood loss. Computer-assisted surgery (CAS) is different from conventional TKA as it avoids opening the intramedullary canal. Hence, CAS should be associated with less blood loss. Methods: Fifty-seven patients were randomized into two groups of CAS and conventional TKA. In conventional group intramedullary femoral and extramedullary tibial jigs were used whereas in CAS group imageless navigation system was used. All surgeries were done under tourniquet. Total and hidden blood loss was calculated in both groups and compared. Results: The mean total blood loss was 980 mL in conventional group and 970 mL in CAS group with median of 1,067 mL (range, 59 to 1,791 mL) in conventional group and 863 mL (range, 111 to 2,032 mL) in CAS group. There was no significant difference in total blood loss between the two groups (p = 0.811). We have found significant hidden blood loss in both techniques, which is 54.8% of the total loss in the conventional technique and 59.5% in the computer-assisted navigation technique. Conclusions: There is no significant difference in total and hidden blood loss in the TKA in CAS and conventional TKA. However, there is significant hidden blood loss in both techniques. There was no relation of tourniquet time with blood loss.

전립선비대증의 경요도전립선절제술에서 출혈에 영향을 미치는 인자

정연태,류현열,장태호 고신대학교 의학부 2000 고신대학교 의학부 학술지 Vol.15 No.1