• Tuberculosis and Respiratory Diseases
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• 제40권3호
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• pp.250-258
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• 1993

연구배경 : 전신마취 수술 후 시간 경과에 따른 부위별 폐기능의 변화를 알아보고, 수술 후 저산소혈증이나 호흡기계 합병증의 예방을 위한 기간을 알아보고자 하였다. 방법 : 전신마취를 시행하여 수술을 받은 환자를 대상으로 흉부 수술 9예, 상복부 수술 21예, 하복부 수술 13예와 말초부 수술 17예를 대상으로 수술전 휴대용 폐기능검사기와 동맥혈가스분석검사를 환자가 가장 안정된 상태에서 실시하고 수술 다음날 동맥혈가스분석검사를 실시하고, 수술후 5일간 휴대용 폐기능검사를 이용하여 폐기능검사를 실시하여 수술전후를 비교하였다. 결과: 1) 흉부 수술의 경우 1초간 노력성호기량및 노력성폐활량은 수술후 5일이 경과하여도 회복되지 않았고, 1초간 노력성호기량/노력성폐활량 비는 변화가 없었으며, 최대호기 유속도 감소되었다. 수술 다음날 동맥혈의 이산화탄소분압이 증가되었다. 2) 상복부 수술시 1초간 노력성호기량, 노력성폐활량, 노력성호기중간유량 및 최대 호기유속은 수술후 5일이 경과하여도 회복되지 않았으며, 수술 다음날의 동맥혈산소분압/산소분율비도 감소하였다. 3) 하복부의 경우 1초간 노력성호기량, 노력성폐활량, 노력성호기중간유량은 수술후 5일에 회복되었으며, 최대호기유속은 수술후 3일에 호전되었다. 수술 다음날의 동맥혈산소분압/산소분율비는 감소되었다. 4) 말초부 수술시 폐기능검사및 동맥혈가스분석검사는 수술 전후 유의한 차이를 보이지 않았다. 결론 : 전신마취를 이용한 수술에서, 흉부 및 상복부 수술시 1주일이상 호흡기 합병증에 대한 가능성이 있으며, 말초부 수술시에는 수술 다음날부터 폐기능 및 동맥혈가스분석검사의 변화가 없어, 수술 당일의 적절한 호흡관리로 수술로 인한 합병증을 예방할 수 있을 것으로 사료된다.

• 대한치과마취과학회지
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• 제13권2호
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• pp.51-54
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• 2013

A 30-year-old man with morbid obesity (height: 176 cm, body weight: 100 kg, body mass index: 32.28) was scheduled for reconstruction of the mandibular fracture. During induction of general anesthesia and nasotracheal intubation, we experienced massive epistaxis, hypoxemia and difficult airway management. Fortunately, we performed oro-tracheal intubation with direct laryngoscopy and it barely succeeded. He recovered without any residual complications and rescheduled seven days later and we successfully performed awake fiberoptic nasotracheal intubation. The patient discharged on the fourth postoperative day.

• Journal of Chest Surgery
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• 제33권3호
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• pp.257-261
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• 2000

Pulmonary arteriovenous fistula can occur in a variety of clinical situations including liver diseases, infections, metastatic carcinomas, systemic disorders, and after the palliation of congenital heart diseases. A 72-day-old male infant with Tetralogy of Fallot and pulmonary atresia underwent surgical correction without difficulty. However, ventilator weaning in the ICU failed initially because of an unexplained postoperative hypoxemia(FiO2: 0.8, PaO2: 40 mmHg, SaO2: 80∼90%). Postoperative follow-up lung perfusin scan at postoperative 15 days showed right-to-left shunt(33.6%) and ventilator weaning was performed on the 20th day after the operation (FiO2: 0.4, PaO2, 50mmHg, SaO2: 86.9%). Arterial oxygen saturation under room air was 80∼85% at 7 months postoperatively. One and half year follow-up lung perfusion scan showed decreased amount of right-to-left shunt (11.2%). We report a case with a review of the literatures.

• Journal of Chest Surgery
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• 제25권4호
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• pp.391-397
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• 1992

Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine was done by Behar and associates for control of postoperative pain. This study was carried out for twenty patients who received posterolateral thoracostomy with Bled resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes. We selected ten of twenty patients, one after the other and treated with epidural analgesia as study group and the remainder ten were grouped as control. Epidural catheters were inserted for study group before operation through T12-L1, 2 interspinous process at the pain clinic or operation room by anesthesiogist and then the drugs[0.25% Bupivacaine 15ml mixing with morphine 3mg] were instillated through the catheter before extubarion and once a day until 4th day, and the patients of control group were treated intermittently by Demerol 50mg intramuscularly for postoperative pain control. The epidural catheters were removed at postoperative 4th day. Observations were done about vital aigns, a-BGA, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; [1] Tidal volume[85.1$\pm$29.8%R VS 60.8$\pm$20.5%R, p<0.05] and FVC[53.7$\pm$14.2%R, VS 35.5$\pm$9.l%R, p<0.01] were significantly improved in study group compared with control group during the first day of operation. [2] But the improvement of FVC was delayed after stopping of epidural analgesia[postoperative 7th day, 97.5$\pm$12.3%R VS 83.9$\pm$15.6%R, P <0.05]. [3] Others were statistically not significant. [4] The side effects of epidural analgesia were identified such as urinary retention[2 cases], itching sensation[1 case] and headache[1 case], but there was no need for active treatments.

• Journal of Chest Surgery
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• 제25권4호
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• pp.429-434
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• 1992

We experienced a rare case of traumatic ventricular septal defect by penetrating stab injury The patient was 26-year-old women who got stab wound at the left anterior third intercostal space and left sternal border with a knife. seven hours after admission, the patient was undertaken an emergency thoracotomy due to hypovolemic shock caused by massive bleeding from transected left internal mammary artery, vein, and right ventricular outflow tract. On postoperative second day, the patient was suffered from moderate dyspnea, and arterial blood gas analysis and chest X-ray revealed hypoxemia and pulmonary edema. Right heart cardiac catheterization with Swan-Ganz Cathater showed oxygen step-up between right atrium and main pulmonary artery and a 1.6:1 ratio of pulmonary to systemic blood flow. At operation, harsh systolic thrill was palpable along right ventricular outflow tract. Through small vertical right ventriculotomy, the linear ventricular septal laceration on infundibular septum was noticed, and its size was 1.5cm with sharp margin This defeat was repaired by three interrupted matress sutures using Prolene 4-O with pledget. Her postoperative course was uneventful, and she discharged with good physical condition.

• Journal of Chest Surgery
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• 제30권9호
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• pp.927-931
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• 1997

신생아에서 선천적 삼첨판 폐쇄부전은 자주 보고되지만 건삭파열에 의한 이차성 삼첨판 폐쇄부전은 아주 드물다. 환아는 생후 1일의 남아로 출생 직후부터 심한 호흡곤란, 청색증 및 산혈증이 관찰되었고, 무호흡과 함께 서맥이 빈번히 나타났다. 심초음파도 검사를 시행하여 폐동맥 판막을 통한 우심유출로 혈류가 관찰되지 않아서 폐동맥 폐쇄증으로 진단되었다. 수술 소견에서 폐동맥 및 폐동맥 판막의 기형은 전혀 없었고, 삼첨판의 전방 유두근 건삭파열이 새로이 확인되었다. 삼첨판 폐쇄부전은 건삭 형성술을 실시하여 성공적으로 교정하였으며, 술전 심초음파도에서 주폐 동맥에 폐혈류가 관찰되지 않았던 것은 심한 삼첨판 폐쇄부전 때문이었던 것으로 판단되었다.

• The Korean Journal of Pain
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• 제5권1호
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• pp.37-43
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• 1992

Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxemia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine for control of postoperative pain was reported by Behar and associates. This study was carried out for twenty patients who received posterolateral thoracostomy with bleb resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes under general endotracheal anesthesia. For the relief of post-thoracotomy pain following of the general anesthesia, we selected ten patients as control group which were treated intermittently IM with injection of pethidine(50 mg) according to the conventional method and another ten patients as study group which were managed with thoracic epidural analgesia. The tip of the catheter was inserted to T4-5 epidural space through T12-L1 or L1-2 interspinous region before the induction of the general anesthesia and then the epidural analgesics(0.25% bupivacaine 15 ml+morphine 3 mg) was injected once a day via the catheter until 4 th POD in the study group. The epidural catheters were removed at postoperative 4 th day in study group. Clinical observations were done about vital signs, ABG, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; (1) The values of $V_T$ and FVC were significantly improved in study group(85% and 66%) as compared with control group(76% and 61%) during the postoperative 4 day of the epidural analgesia. (2) After the end of the epidural analgesia(7th POD), the values of FVC were improved invertly rather in control group(98%) than study group(84%). It suggested that the reduction of FVC in study group were caused by the raised pain sensitivity following the end of epidural analgesia. (3) The side effects of epidural analgesia such as transient urinary retention(2 cases), itching sensation(1) and headache(1) were noted.

• Journal of Chest Surgery
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• 제51권5호
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• pp.344-349
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• 2018

Background: We report our surgical technique for nonintubated uniportal video-assisted thoracoscopic surgery (VATS) pulmonary resection and early postoperative outcomes at a single center. Methods: Between January and July 2017, 40 consecutive patients underwent nonintubated uniportal VATS pulmonary resection. Multilevel intercostal nerve block was performed using local anesthesia in all patients, and an intrathoracic vagal blockade was performed in 35 patients (87.5%). Results: Twenty-nine procedures (72.5%) were performed in patients with lung cancer (21 lobectomies, 6 segmentectomies, and 2 wedge resections), and 11 (27.5%) in patients with pulmonary metastases, benign lung disease, or pleural disease. The mean anesthesia time was 166.8 minutes, and the mean operative duration was 125.9 minutes. The mean postoperative chest tube duration was 3.2 days, and the mean hospital stay was 5.8 days. There were 3 conversions (7.5%) to intubation due to intraoperative hypoxemia and 1 conversion (2.5%) to multiportal VATS due to injury of the segmental artery. There were 7 complications (17.5%), including 3 cases of prolonged air leak, 2 cases of chylothorax, 1 case of pleural effusion, and 1 case of pneumonia. There was no in-hospital mortality. Conclusion: Nonintubated uniportal VATS appears to be a feasible and valid surgical option, depending on the surgeon's experience, for appropriately selected patients.

• Journal of Trauma and Injury
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• 제28권1호
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• pp.34-38
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• 2015

The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권4호
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• pp.179-192
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• 2023

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.