• Journal of Chest Surgery
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• 제26권11호
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• pp.856-860
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• 1993

We performed serial pulmonary function test and arterial blood gas analysis at preoperative period and postoperative 1st week in 337 patients who underwent pulmonary resection from May 1988 to April 1992 at Dept. of Thoracic and Cardiovascular Surgery, Seoul adventist hospital. Follow-up study for PFT and ABGA were possible in 30 % of the patients at postoperative 3rd or 4th month. In patient who underwent pneumonectomy, VC was decreased from 57.7% to 46.1%, FVC was decreased from 53.5 % to 41.2 % and MBC also decreased from 68.1% to 49.6 % at postoperative 1st week. But ABGA revealed that POa-, was increased from 87.2 mmHg to 92.7 mmHg, and PCO2 was decreased from 43.2 mmHg to 35.9 mmHg at postoperative 1st week. In patients who underwent lobectomy, VC was decreased from 78.1% to 68.30 %, FVC was decreased from 72.5% to 55.3% and MBC was decreased from 73.5% to 68% at postoperative 1st week.But, ABGA revealed that PO2 was increased from 95.2 mmHg to 97.9 mmHg and PCO2 was decreased from 42.3 mmHg to 39.0 mmHg at postoperative 1st week. The pulmonary function recovered at postoperative 3rd or 4th month and its ratio to preoperative value was 90% in lobectomy cases, but in pneumonectomy cases VC and MBC were recovered 20% and 15 % above the preoperative values. We concluded that resection of atelectasis, destructed lung, open negative and open positive cavity in the pulmonary tuberculosis were beni~t to improve ventilation-perfusion ratio,and pulmonary function was recovered nearly to preoperative level at postoperative 3rd or 4th month.

• Journal of Chest Surgery
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• 제19권2호
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• pp.188-196
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• 1986

Spirometry and regional function studies using 99m-Technetium were performed preoperatively to predict postoperative pulmonary function change in 34 patients who had various pulmonary resectional procedures at the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. Between two months and fourteen months postoperation all the patients were reinvestigated with spirometry and clinical examination to evaluate their functional respiratory status. The postoperative obtained values, especially forced vital capacity [FVC] and forced expiratory volume in one second [FEV1] among the other parameters were compared with the postoperative predicted values. Estimated values of FVC and FEV1 derived from preoperative spirometry and quantitative perfusion lung scan correlated well with the measured postoperative values. The linear regression line derived from correlation between postoperative estimated[X] and postoperative measured[Y] values of FVC and FEV1 in all patients are as follows; 1. Y=0.76x + 0.39 in correlation of FVC [r=0.91] 2. Y=0.88x + 0.17 in correlation of FEV1 [r=0.96],br> This method of estimation was one of the best methods of predicting postoperative pulmonary function change and valuable in determining the extent of safe resection and postoperative prognosis to a poor risk patient with chronic obstructive lung disease.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1218-1220
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• 1992

Pneumonectomy on a patient with documented poor pulmonary function indicating a contraindication to surgery can be associated with a high risk of serious postoperative morbidity or mortality. However the usual criterias, on the performance of a pneumonectomy on a high risk patient based on the preoperative assessment of the pulmonary function may not sometimes predict with accuracy the operative outcome in the postoperative period. We recently performed pneumonectomy with good results on a patient with poor pulmonary function that would otherwise have been an absolute contraindication to surgery by usual criteria.

• The Korean Journal of Pain
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• 제13권1호
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• pp.31-37
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• 2000

Background: Recent studies suggested that a preoperative block of N-methyl-D-aspartate (NMDA) receptors with NMDA antagonists may reduce postoperative pain. In this double-blind study, magnesium sulfate, a natural NMDA receptor antagonist, was administered preoperatively to investigate the effects of magnesium sulfate on postoperative pain and pulmonary function. Methods: Seventy patients who were to undergo gastrectomy under general anesthesia were randomly assigned to one of three groups. Groups 2 and 3 received intravenous magnesium, preoperatively (Group 2: 50 mg/kg bolus, 7.5 mg/kg/hr for 20 hr, Group 3: 50 mg/kg bolus, 15 mg/kg/hr for 20 hr). Group 1 received normal saline as the control group. Visual analog scale (VAS) for postoperative pain and mood, cumulative analgesic consumption, recovery of pulmonary function and side effects were evaluated at 6, 24, 48 and 72 hours after the operation. Results: In Groups 2 and 3, plasma concentration of magnesium were significantly higher than in Group 1 at 6 and 20 hours after infusion (P<0.05). There were no significant differences in the analgesic consumption, and recovery of pulmonary function and the incidence of side effects at 6, 24, 48 and 72 hours after the operation among the three groups. In Group 3, pain scores at rest measured 24 and 48 hours after operation were lower than the control group, and pain scores when deep breathing were significantly lower than the control group at postoperative 6, 24, 48, and 72 hours. Conclusions: We conclude that intravenous infusion of greater amount of magnesium has little effectiveness in reducing postoperative pain. However, further studies are needed to characterize the clinical significance of these effects on postoperative pain.

• 기본간호학회지
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• 제1권1호
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• pp.69-76
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• 1994

This study was designed and undertaken to find out the effectiveness of VAS for evaluation of general anesthetic postoperative pulmonary-function. We compared the degree of perceived pulmonary function recovery with peak expiratory flow at postoperative 72 hours of subjects. The subjects of this study were collected 38 patients who had received upper abdominal operation in St. Paul Hospital, Catholic University Medical College, and Kangnam Scared Heart Hospital and Kangdong Scared Heart Hospital, Hallym University. Data collection period was from June 15th, to August 7th, 1992. The degree of pulmonary recovery function was measured with peak expiratory at 72 hours postoperatively. The degree of perceived pulmonary function of the patient was measured with ten points visual analog scale at 72 hours postoperatively. Peak expiratory flow and visual analog score was analyzed with Pearson correlation. Peak expiratory flow was expressed as a ratio of preoperative value. The result was as follows : The recovery of pulmonary function and the degree of perceived pulmonary function of the patient at 72hours postoperatively was revealed high correlation (r=.84). The above result suggested that patients with general anesthetic upper abdominal surgery should evaluate recovery of pulmonary function making use of VAS. We know that VAS is very useful in postoperative patients. We perceived that VAS is to take up a positive attitude of patients. Nurse should furnish the nursing care objectively and scientifically to patients. As VAS was economic and simple, VAS should be adviced for wider application.

• Journal of Chest Surgery
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• 제28권4호
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• pp.371-375
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• 1995

Surgical resection of lung cancer or other disease is recently required in patients with severely impaired lung function resulting from chronic obstructive pulmonary disease or disease extension. So prediction of pulmonary function after lung resection is very important in thoracic surgeon. We studied the accuracy of the prediction of postoperative pulmonary function using perfusion lung scan with 99m technetium macroaggregated albumin in 22 patients who received the pneumonectomy. The linear regression line derived from correlation between predicting[X and postoperative measured[Y values of FEV1 and FVC in patients are as follows: 1 Y[ml =0.713X + 381 in FEV1 [r=0.719 ,[P<0.01 2 Y[ml =0.645X + 556 in FVC [r=0.675 ,[P<0.01 In conclusion,the perfusion lung scan is noninvasive and very accurate for predicting postpneumonectomy pulmonary function.

• Journal of Chest Surgery
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• 제13권4호
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• pp.364-374
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• 1980

Twenty-two patients were selected for evaluation of pre-and postoperative pulmonary function. These patients were performed open cardiac surgery with the extracorporeal circulation from March 1979 to July 1980 at the Department of Thoracic and Cardiovascular Surgery, Kyungbook National University Hospital. Patients were classified with ventricular septal defect 5 cases, atrial septal defect 5 cases, tetralogy of Fallot 5 cases, mitral stenosis 4 cases, rupture of aneurysm of sinus Valsalva 1 case, left atrial myxoma I case, and aortic insufficiency 1 case. The pulmonary function tests were performed and listed: [1] respiratory rate, tidal volume [TV], and minute volume[MV], [2] forced vital capacity [FVC] and forced expiratory volume[FEV 0.5 & FEV 1.0], [3] forced expiratory flow [FEF 200-1200 ml & FEF 25-75%]. [4] Maximal voluntary ventilation [MVV], [5] residual volume [RV] and functional residual capacity[FRC], measured by a helium dilution technique. Respiratory rate increased during the early postoperative days and tidal volume decreased significantly. These values returned to the preoperative levels after postoperative 5-6 days. Minute volume decreased slightly, but essentially unchanged. Preoperative mean values of the forced vital capacity, functional residual capacity and total lung capacity decreased [63.2%, 87.2% & 77.3% predicted, respectively], and early postoperatively these values decreased further [19.6%, 76.0% & 38.0% predicted], but later progressively increased to the preoperative levels. In residual volume, there was no decline in the preoperative mean values [100.9% predicted] and postoperatively the value rather increased [106.3-161.7% predicted]. Forced expiratory volume [FEV 0.5 & FEV 1.0] and forced expiratory flow [FEF 200-1200 ml & FEF 25-75%] also revealed significant declines in the early postoperative period. There was no significant difference in values of the spirometric pulmonary function tests, such as FEF 1.O and FEF 25-75% between successful weaning group [17 cases] extubated within 24 hrs post-operatively and unsuccessful weaning group [5 cases] extubated beyond 24 hrs. Static compliance and airway resistance measured for the two cases during assisted ventilation, however, any information was not obtained. Long term follow-up pulmonary function studies were carried out for 8 cases in 9 months post-operatively. All of the results returned to the pre-operative or to normal predicted levels except FVC, FEV 1.0, and FEF 25-75% those showed minimal declines compared to the pre-operative figures.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1169-1179
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• 1992

To determine the period and degree of full recovery of postoperative pulmonary function, the author performed seiral pulmonry function test with spirometry at preoperative period and 1st, 2nd, 3rd, 4th, 6th and 8th postoperative week in 64 patients who underwent chest surgery form 1990. 1. to 1990. 8. at Dep. of Thoracic & Cardiovascular surgery, Pusan National University Hospitcal, Pusan, Korea 28 patients underwent lung resection[Group A], 14 patients mediastinal and other thoracic surgery[Group B], and 22 patients heart surgery with cardiopulmonary bypass[Group C]. Al of them recovered normally and discharged without any complications. Their serial changes of pulmonary function test were compaired and its results was as follows; l. Over all mean recovery time of restrictive ventilatory function tests[ie, VC, ERV, IC, FEF1, FVC, FEF200-1200, MVV] were 4th & 6th postoperative week, and that of obstructive ventilatory function tests[ie., EFE25-75%, Vmax50] were 2nd postoperative week. 2. In patient who underwent lung resection surgery[Group A], FEF1 recovered in 4th~6th postoperative week and its ratio to preoperative value was 70% in pneumonectomy, and 75% in lobectomy. FVC recovered in 4th~6th postoperative week and its ratio to preoperative value was 65% in pneumonectomy, and 80% in lobectomy. MVV was recovered in 4th~8th postoperative week and recovery ratio was 80%, FEF200-1200 was recovered at 4th~6th postoperative week and its recovery ratio was 70%, FEF25-75% and Vmax50 was recovered in 2nd~4th postoperative week and recovered nearly to preoperative level. 3. In patient who underwent mediastinal and other thoracic surgery[Group B], FEV1 and FVC and recovered in 4th~6th postoperative week and the recovery ratio of FVC in blebectomy was 90%. MVV reached preoperative level in 4th~8th postoperative week. FEF200-1200, FEF25-75% and Vmax50 were recovered in 2nd~4th postoperative week and the recovery of FEF25-75% and Vmax50 in blebectomy was prominant. 4. In patient who underwent heart surgery[Group C], FEV1 and FVC were recovered in 4th~6th postoperative week. The recover ratio of FEF25-75% and Vmax50 was delaied to 6th~8th postoperative week From the above results we concluded that the recovery time of posoperative restrictive ventilatory disorder was 4th postoperative week and pulmonary complication would possibly occure during that period. So more intensive observations will be needed.

• Journal of Chest Surgery
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• 제18권3호
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• pp.517-528
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• 1985

Pulmonary function studies today are generally accepted as an integral part of the evaluation of poor-risk patients who are to have pulmonary surgery. The effect of various pulmonary surgery on lung function was investigated in 54 patients in whom comprehensive lung function test were performed before and between 2 months and 14 months after operation at the Department of Thoracic Surgery, Seoul National University Hospital. According to the result of analysis, the effect of pulmonary resection on forced flow rate was keeping with the change of lung volume, and the preoperative level of ventilatory function plays a major role in determining postoperative loss of functioning lung. Although all measures of expiratory flow [FVC, FEV1, FEFO.2-1.2, MEF50, FEF25-75] have the same percentage of reproducibility, but FEV1 shows most sensitive, reliable linear correlation with the functioning pulmonary tissue loss than other parameters. The linear regression lines derived from the correlation between preoperative [X] and postoperative [Y] FEV1 on various surgical procedures were as follows: 1. Y = 0.57X 0.03. in pneumonectomy group of lung cancer[r=0.84]. 2. Y = 0.56X + 0.33. in lobectomy group of lung cancer[r=0.79]. 3. Y = 0.69X + 0.25. in lobectomy group of pulmonary infection[r=0.91].

• Journal of Chest Surgery
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• 제2권2호
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• pp.141-146
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• 1969

The importance of bronchial occlusion which occurs in the natural course of tuberculosis as an inconstant but very fortunate event became obscured with the popularity of resection therapy for pulmonary tuberculosis and the resectional surgery and thoracoplasty are the standard method of surgical procedure in the treatment of pulmonary tuberculosis. However in some cases of far advanced pulmonary tuberculosis, the need for another surgical methods arise when standard method is not indicated under the consideration of poor pulmonary function or operative and postoperative complications such as bronchial fistula. The ligation and division of bronchus draining the involved part of the lung is one of the applicable method among the another surgical procedures. The authors experienced one case of far advanced pulmonary tuberculosis who had a huge cavity in the right upper lobe and a small cavity in the superior segment accomanying with several nodular densities in the basal segment and contralateral left lung field, and treated with right upper lobectomy, ligation and division of the superior segmental bronchus and concomitant rib-resectional thoracoplasty in order to prevent postoperative bronchial fistula and to preserve maximal lung function. The postoperative course was smooth without complication regarding to bronchial ligation and division technique and the general condition has been excellent without symptoms. The postoperative sputum examination for AFB on smear and culture has been negative during the 11 month period of follow up, and X-ray of the chest including tomography demonstrated no evidence of residual cavity indicating succesful collapse of cavity.