• Journal of Trauma and Injury
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• 제33권1호
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• pp.23-30
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• 2020

Purpose: Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations. Methods: This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups. Results: We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%. Conclusions: Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

• Clinical and Experimental Pediatrics
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• 제48권6호
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• pp.649-654
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• 2005

목 적 : 본 연구는 고빌리루빈혈증이 유도된 신생자돈에서 비 침습적인 NIRS을 통한 뇌의 혈역학적 변화에 대해 알아보고자 하였다. 방 법 : 17 마리의 신생자돈을 대상으로 정상 대조군(CG, n=6), 고빌리루빈혈증군(BG, n=7마리), 7-NI를 투여한 고빌리루빈 혈증군(NG, n=4)으로 무작위 구분하였다. 고빌리루빈혈증의 유도는 40 mg/kg의 빌리루빈을 농축괴로 정주한 후 곧 이어 30mg/kg/hr로 4시간 동안 지속 정주하여 혈중 빌리루빈 농도를 20 mg/dL 이상으로 유지하였고 7-NI는 빌리루빈을 농축괴로 투여한 전과 후에 50 mg/kg을 복막투여 하였다. 모든 실험군은 실험 기간 동안 뇌의 혈역학적 변화를 위해 NIRS로 감시하였고 뇌 조직을 적출하여 생화학적인 변화를 관찰하였다. 결 과 : 동맥혈의 base excss, pH, 평균 동맥압은 BG군과 NG군에서 CG군에 비해 유의하게 감소하였다. BG군에서 유의하게 뇌 조직의 $Na^+$, $K^+$-ATPase activity, ATP, PCr은 유의하게 감소하고 conjugated dienes는 유의하게 증가하였으나 NG 군은 이런 이상소견이 유의하게 완화되었다(P<0.05). 뇌 혈역학적 검사상 [$HbO_2$], [HbT], 및 [HbD]는 BG군에서 CG군에 비해 유의하게 감소하였고(P<0.05) NG군은 CG군과 차이가 없었다. 실험 종료시 $ScO_2$는 세 군간에 유의한 차이가 없었다. 결 론 : 고빌리루빈혈증이 유도된 신생자돈에서 뇌의 혈역학적인 변화를 비침습적인 NIRS의 감시를 통해 유용하게 관찰할 수 있었다.

• 한국임상약학회지
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• 제28권2호
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• pp.101-106
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• 2018

Objective: The purpose of the study was to investigate the time from the injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients undergoing laparoscopic cholecystectomy. Methods: This study was retrospectively conducted on patients who were diagnosed with gallbladder stone (N802) between January 2014 and April 2017. The data were collected from the electronic medical records of a total of 186 patients (84 patients in the neostigmine group and 102 patients in the sugammadex group). Results: The time required for the first spontaneous respiration in the sugammadex group was shorter than that in the neostigmine group (3.6 min vs 4.9 min; p<0.05). After the injection of intermediate muscle relaxants, the comparison of heart rate and mean arterial pressure in the sugammadex and neostigmine groups revealed that the heart rate in the neostigmine group was higher than in the sugammadex group after 5 min (p<0.05). The mean arterial pressure in the neostigmine group was higher than in the sugammadex group after 10 min (p<0.05). A significant adverse effect of tachycardia was observed in the neostigmine group (p<0.05), but the frequency of rescue antiemetic in the sugammadex group was significantly higher than in the neostigmine group (p<0.05). Conclusion: In this study, the unwanted effect of neostigmine group was tachycardia; therefore, in the case of patients with hemodynamic instability, sugammadex is recommended. At 12 hours after the injection of sugammadex to patients, more antiemetics were required than in the neostigmine group; therefore, more research should be conducted on postoperative nausea and vomiting.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권2호
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• pp.145-153
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• 2022

Background: Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods: A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 ㎍) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann-Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results: The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion: Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

• Journal of Korean Neurosurgical Society
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• 제67권4호
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• pp.442-450
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• 2024

Objective : Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. Methods : A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Results : Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. Conclusion : The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.212-218
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• 2018

Objective : Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. Methods : From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively. Detailed case-by-case analysis was performed based on preoperative, postoperative and follow-up radiologic examinations and operative findings. All clinical variables including age, sex, aneurysm size and location, type and number of applied clips, prognosis, and time to recurrence are evaluated. All patients are classified by causes of the recurrence. Possible risk factors that could contribute to those causes and overcoming ways are comprehensively discussed. Results : All recurrent aneurysms after surgical clipping were 14 of 2364 (0.5%). Three cases were males and 11 cases were females. Mean age was 52.3. At first treatment, nine cases were ruptured aneurysms, four cases were unruptured aneurysms, and one case was unknown. Locations of recurrent aneurysm were determined; anterior communicating artery (A-com) (n=7), posterior communicating artery (P-com) (n=3), middle cerebral artery (n=2), anterior cerebral artery (n=1) and basilar artery (n=1). As treatment of the recurrence, 11 cases were treated by surgical clipping and three cases were treated by endovascular coil embolization. Three cases of all 14 cases occurred in a month after the initial treatment. Eleven cases occurred after a longer interval, and three of them occurred after 15 years. By analyzing radiographs and operative findings, several main causes of the recurrent cerebral aneurysm were found. One case was incomplete clipping, five cases were clip slippage, and eight cases were fragility of vessel wall near the clip edge. Conclusion : This study revealed main causes of the recurrent aneurysm and contributing risk factors to be controlled. To manage those risk factors and ultimately prevent the recurrent aneurysm, neurosurgeons have to be careful in the technical aspect during surgery for a complete clipping without a slippage. Even in a perfect surgery, an aneurysm may recur at the clip site due to a hemodynamic change over years. Therefore, all patients must be followed up by imaging for a long period of time.

• Neonatal Medicine
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• 제25권2호
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• pp.78-84
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• 2018

Purpose: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. Methods: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC. Results: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). Conclusion: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

• 한국임상수의학회지
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• 제29권6호
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• pp.447-454
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• 2012

본 실험에서는 propofol과 remifentanil 병용 마취법 사용 시 안압 및 혈액학적 변화를 측정하고 isoflurane 마취 결과와 비교하였다. 건강한 14마리의 비글견을 7마리씩 2군 (PRP군, ISF군)으로 나누었으며 PRP군은 마취 도입 10분 전에 acepromazine (0.05 mg/kg, IV)으로 전마취제 투여하고 atracurium 0.1 mg/kg 투여 후, propofol (5 mg/kg, IV)으로 마취 유도하였다. 마취 유지에는 propofol (0.2 mg/kg/min)과 remifentanil ($0.5{\mu}g/kg/min$)을 사용하였다. ISF군에서는 propofol (5~7 mg/kg, IV)로 마취를 유도하고, isoflurane 흡입마취법으로 마취를 유지하였다. 초기 isoflurane 농도를 3%으로 유지하다가 마취가 안정된 후 1.9%로 낮추어 유지 하였다. 모든 군에서 간헐적인 100% 양압 호흡을 사용해 $CO_2$는 38에서 45 mmHg사이를 유지하고 $SpO_2$는 95에서 100사이를 유지하였다. 총 마취 시간은 90분이었으며 안압, 혈압, 심박수를 각각 5, 10, 15, 30, 45, 60, 75, 90에 측정을 하였다. 실험 결과 propofol과 remifentanil 병용마취법이 isoflurane 흡입마취법 보다 안정적으로 안압과 혈압을 낮출 수 있었다.

• 한국임상수의학회지
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• 제27권2호
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• pp.136-141
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• 2010

개에서 Medetomidine (MED)과 tiletamine/zolazepam (ZT) 병용마취시에 통증자극에 대한 반응으로 판단되는 외과적 마취기에 적절한 진통효과가 나타나는지를 확인하기 위해 뇌파를 이용하여 실험을 실시하였다. 임상적으로 건강한 비글견 7두를 이용하여 동일견을 대조군과 통증자극군에 이용하였다, 대조군은 MED $30\;{\mu}g/kg$ 투여 후 15분에 ZT 10 mg/kg을 각각 근육주사하였으며, 통증자극군은 대조군과 동일한 방법으로 약물을 투여한 다음 ZT 투여 후 10분부터 45분까지 5분 간격으로 pedal withdrawal reflex test를 실시하였다. 각각의 기록시간대에서 뇌파의 band power,평균동맥혈압과 심박수를 측정하여 실험군간 비교하였다. 뇌파 기록전극은 International 10-20 system을 이용하여 Cz에, 기준전극과 접지전극은 양쪽 귀에 장착하였다. 뇌파 분석상 저주파 band가 높은 power를 보이고 고주파 band가 낮은 power를 나타냈으나 군간 유의성 있는 차이는 발견할 수 없었다. 평균 동맥혈압과 심박수는 TZ 투여 10분 후 두 군 모두 상승하였으나 군간 유의성은 없었다. 본 실험 결과, 개에서 MED와 ZT 병용마취는 외과적 마취기에 우수한 진통효과를 제공하는 것으로 사료된다.

• Journal of Chest Surgery
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• 제31권6호
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• pp.567-575
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• 1998

최근 심장 분야 수술의 발달로 여러 가지 고난도의 심장 수술과 심장 이식술의 시행이 증가하고 있으며, 술 후 예후에 크게 영향을 주는 심장의 심근 손상 방지에 대한 다각적인 연구가 행해지고 있는데, 수술 및 이식 전후의 허혈기와 재관류시 발생할 수 있는 심근 손상을 최소화하고, 술 후 심근 기능의 조속한 회복을 위한 목적으로 여러 약제 및 방법을 제시하고 있다. 한편 한국에서는 오래 전 부터 만병 통치의 영약으로 전해져 오고 있는 인삼을 이용한 동물 실험 및 임상 경험을 통해 성분 효과에 대한 여러 결과가 보고되고 있고, 심장 기능에 대한 효과도 약리학적 측면에서 많은 결과가 발표되었다. 그런데 여러 분획 추출물 중 ginsenoside Rg1 mixtures에 대해서는 그 결과가 다소 미비한 상태이고 ginsenoside Rb1과의 이원 작용에 대한 결과가 흥미로울 것으로 판단되었으며 여러 저자들의 결과에 차이가 있어 ginsenoside Rg1을 이용하여 심근의 허혈 후 재관류 시행 10분 및 지속적 관류 상태에서의 심근 손상에 대한 심근 보호 정도를 혈역학적 지표 및 관상 혈류를 통한 관류액의 효소치를 측정하여 실험한 결과 심근 허혈 및 재관류 후 심근 손상 방지와 심근 기능 회복에 효과가 있다고 판단되며 향후 약제의 투여 용량에 따른 심근 보호 정도에 관한 실험이 필요할 것으로 사료되고, 인삼 성분 각 분획의 복합 투여에 의한 결과도 재차 확인하여야 할 것으로 생각된다.