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전신적 동맥경화성 혈관염 환자의 수술 후 경막외마취가 혈액응고에 미치는 효과

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Author(s)
최윤정김진모김애라Yoon Jeong ChoiJin Mo KimAe Ra Kim
Keimyung Author(s)
Kim, Jin MoKim, Ae Ra
Department
Dept. of Anesthesiology & Pain Medicine (마취통증의학)
Journal Title
대한마취과학회지
Issued Date
2000
Volume
38
Issue
3
Abstract
Background: The purpose of this study was to examine the relationship of epidural anesthesia with coagulation status and surgery outcome following lower extremity revascularization.
Methods: Twenty patients with arteriosclerosis obliterance (ASO) scheduled for lower extremity vascular reconstruction were randomized to receive either general anesthesia or combined genetal-epidural anesthesia. An additional 20 randomly selected patients without atherosclerotic vascular disease undergoing lower abdominal or lower extremity surgeiy served as controls for coagulation status. In the group with general anesthesia, anesthesia was induced by administration of pentothal sodium and succiny-Icholitie and maintained with N2O-O2, isofhirane and vecuronium. In the group with combined anesthesia, epidural anesthesia was performed at the level of L2-3 or L3-4 epidural space using 2% lidocaine, followed by general anesthesia same as general group. Postoperative pain control was followed by on-demand oral or intravenous narcotics in the general group and followed by epidural 0.125% bupivacaine and morphine in the combined group. The coagulation status was monitored using thrombelastography (TEG) and standard coagulation tests.
Results: The ASO patients were hypercoagulable compared to the control patients before operation and on the first postoperative day. Hie hypercoagulability was attenuated postoperatively in the combined group. In the ASO-general group, postoperative MA, a and TEG index were 69.5 士 6.1 mm, 53.3 士 7.5° and 1.18 土 1.29 respectively, but in the ASO-combined anesthesia group, they were 58.0 土 62 mm, 38.0 土 4.0 ‘ and -0.38 土 1.20 respectively (P < 0.05). The rates of postoperative complications did not significantly differ between the two groups.
Conclusions: In patients with arteriosclerosis obliterance undergoing arterial reconstructive surgeiy, thrombelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and epidural anesthesia is associated with beneficial effects on coagulation status.
Alternative Title
The Effect of Epidural Anesthesia on Coagulation Following Vascular Surgery in Patients with Arteriosclerosis Obliterance
Keimyung Author(s)(Kor)
김진모
김애라
Publisher
School of Medicine
Citation
최윤정 et al. (2000). 전신적 동맥경화성 혈관염 환자의 수술 후 경막외마취가 혈액응고에 미치는 효과. 대한마취과학회지, 38(3), 409–419. doi: 10.4097/kjae.2000.38.3.409
Type
Article
ISSN
0302-5780
DOI
10.4097/kjae.2000.38.3.409
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/40099
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Anesthesiology & Pain Medicine (마취통증의학)
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