• 제목/요약/키워드: Post anesthesia

검색결과 240건 처리시간 0.027초

Comparative evaluation of the effectiveness of two innovative methods in the management of anxiety in a dental office: a randomized controlled trial

  • Panchal, Jay;Panda, Anup;Trivedi, Krishna;Chari, Deepika;Shah, Rushita;Parmar, Binny
    • Journal of Dental Anesthesia and Pain Medicine
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    • 제22권4호
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    • pp.295-304
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    • 2022
  • Background: The first dental experience is vital in molding a child's attitude towards dentistry and dental outcomes. The cooperation of a child during dental treatment is essential to render successful and high-quality treatment. Dental anxiety is common in children undergoing dental treatment. The success of pediatric dental treatments and patient comfort depends on controlling the levels of patient anxiety in clinical settings. This study aimed to compare the effectiveness of the recorded maternal voice and virtual cognitive tool (Roogies application) in the management of pediatric dental patients. Methods: The study was carried out with children aged of 4-7 years [n = 80, (40 male and 40 female)], without any past dental history, and were randomly allocated into two groups. After informed consent was obtained, the entire procedure was explained to the parents. Anxiety was assessed pre-, during, and post-treatment by measuring pulse rate, and recording Venham Picture Test (VPT) scores. Group A [n = 40; 20 boys and 20 girls)] was provided with a headphone that played a recorded maternal voice. Group B [n = 40; 20 boys and 20 girls)] was administered the virtual cognitive tool. After conditioning the children, oral prophylaxis was performed for both groups. A comparative evaluation was conducted for each treatment session. Results: The intra-group comparison of VPT scores and heart rate for patients assigned to the recorded maternal voice showed a statistically significant difference in dental anxiety (P-value ≤0.001). Conclusion: This study demonstrated that a reduction in dental anxiety with the help of recorded maternal voice forms an important component of non-pharmacological behavior management. Alternatively, the use of a virtual cognitive tool as an anxiety-reducing technique can also be advocated.

Early initiation of breastfeeding and factors associated with its delay among mothers at discharge from a single hospital

  • Mary, J. Jenifer Florence;Sindhuri, R.;Kumaran, A. Arul;Dongre, Amol R.
    • Clinical and Experimental Pediatrics
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    • 제65권4호
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    • pp.201-208
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    • 2022
  • Background: According to the National Family Health Survey-4, in India, 78.9% of deliveries occur in institutions, although only 42.6% of new mothers initiate breastfeeding within 1 hour of delivery. Purpose: To estimate the proportion of early initiation of breastfeeding (EIBF) among new mothers at discharge from a tertiary care hospital and identify the determinants of delayed initiation of breastfeeding among them. Methods: This was a hospital-based analytical cross-sectional study of 108 new mothers. After obtaining Institutional Review Board approval and informed consent, we interviewed the new mothers on the day of discharge. Multivariate logistic regression was performed using IBM SPSS Statistics ver. 24. Results: The median breastfeeding initiation time was 90 minutes (interquartile range, 30-180 minutes). Overall, 43.5% of the mothers practiced EIBF, 77.4% practiced exclusive breastfeeding, and 43.5% were rooming in at discharge. Reasons for breastfeeding delays included extended recovery time from spinal anesthesia, maternal lassitude, and uncomfortable breastfeeding position due to post-cesarean pain. In the multivariate analysis, a birth weight less than 2,500 g (adjusted odds ratio [aOR], 4.33; 95% confidence interval [CI], 1.12-16.82; P=0.03), cesarean section delivery (aOR, 4.68; 95% CI, 1.57-13.92; P=0.005), and mother's poor knowledge of breastfeeding (aOR, 4.61; 95% CI, 1.44-14.72; P=0.010) were more likely to delay the initiation of breastfeeding. Conclusion: EIBF was practiced by less than half of the new mothers as determined by the cesarean section, baby's birth weight, and mothers' awareness of breastfeeding. Thus, it is vital to improve breastfeeding and nutritional counseling among mothers during the antenatal period and improve healthcare professionals' training to facilitate EIBF, even in circumstances such as cesarean section.

Ultrasound-guided erector spinae plane block for pain management after gastrectomy: a randomized, single-blinded, controlled trial

  • Jeong, Heejoon;Choi, Ji Won;Sim, Woo Seog;Kim, Duk Kyung;Bang, Yu Jeong;Park, Soyoon;Yeo, Hyean;Kim, Hara
    • The Korean Journal of Pain
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    • 제35권3호
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    • pp.303-310
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    • 2022
  • Background: Open gastrectomy causes severe postoperative pain. Therefore, we investigated the opioid-sparing effect of the ultrasound-guided bilateral erector spinae plane block (ESPB) after open gastrectomy. Methods: Adult patients undergoing open gastrectomy were randomly assigned to either the ESPB group (ESPB + fentanyl based intravenous patient-controlled analgesia [IV-PCA]) or a control group (fentanyl based IV-PCA only). The primary outcome was total fentanyl equivalent consumption during the first 24 hour postoperatively. Secondary outcomes were pain intensities using a numeric rating scale at the post-anesthesia care unit (PACU) and at 3, 6, 12, and 24 hour postoperatively, and the amount of fentanyl equivalent consumption during the PACU stay and at 3, 6, and 12 hour postoperatively, and the time to the first request for rescue analgesia. Results: Fifty-eight patients were included in the analysis. There was no significant difference in total fentanyl equivalent consumption during the first 24 hour postoperatively between the two groups (P = 0.471). Pain intensities were not significantly different between the groups except during the PACU stay and 3 hour postoperatively (P < 0.001, for both). Time to the first rescue analgesia in the ward was longer in the ESPB group than the control group (P = 0.045). Conclusions: Ultrasound-guided ESPB did not decrease total fentanyl equivalent consumption during the first 24 hour after open gastrectomy. It only reduced postoperative pain intensity until 3 hour postoperatively compared with the control group. Ultrasound-guided single-shot ESPB cannot provide an efficient opioid-sparing effect after open gastrectomy.

Comparison of Ventral Midline and Right Flank Approaches of Ovariohysterectomy in Bitches

  • Ishwor Dhakal;Bharata Regmi;Bablu Thakur;Ishwari Tiwari;Shraddha Tiwari;Yeonsu Oh;Manoj K. Shah
    • 한국임상수의학회지
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    • 제40권1호
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    • pp.25-30
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    • 2023
  • The ventral midline approach (VMA) and right flank approach (RFA) are common procedures for the sterilization of bitches. This study compared the different parameters viz. total duration of surgery, recovery time, and length of the incision as well as body temperature, heart rate, respiration rate, and SpO2 in each approach. Twenty (20) bitches were divided randomly for the RFA and VMA. Meloxicam (0.2 mg/kg) was administered subcutaneously half an hour before the induction to provide preemptive analgesia. Diazepam and ketamine were administered intravenously at dose rates of 0.25 mg/kg and 2.5 mg/kg, and 0.17 mg/kg and 3.33 mg/kg, respectively to produce and maintain anesthesia. Each parameter was recorded at the pre-operative, operative and post-operative times. The average duration of surgery and length of incision of RFA (16.1 ± 5.13 min and 2.44 ± 0.83 cm) were significantly lower (p < 0.05) than the VMA (21.3 ± 5.48 min and 3.53 ± 0.7 cm). The operated bitches showed hypothermia (p < 0.05) at 1 hour compared to baseline and 24 hours of surgery. Heart and respiration rates increased significantly (p < 0.05) during traction and severing of ovarian ligaments in bitches within the RFA group, but there was no significant difference within VMA approaches. The sedation score was significantly higher (p < 0.05) at 1 hour after surgery in both approaches. Based on the duration of surgery and length of incision RFA approach was quick and minimal skin wound. Further studies on bitches considering molecular investigations of surgical stress are imperative.

Fontan 수술을 받은 정신지체 소아에서 인상채득을 위해 시행한 깊은 진정 (Deep Sedation for Palate Alginate Impression Procedure in a Post-Fontan Procedure Patient with Mental Retardation)

  • 이정만;서광석;김현정;신순영;신터전
    • 대한치과마취과학회지
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    • 제12권1호
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    • pp.45-50
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    • 2012
  • The Fontan operation is a heart operation used to treat complex congenital heart defects like tricuspid atresia, hypoplastic left heart syndrome, pulmonary atresia and single ventricle. A single ventricle is dedicated to pumping oxygenated blood to the systemic circulation and the entire systemic venous return reaches the pulmonary arterial system without the direct influence of a pumping chamber. In the patient with Fontan operation, it is important to achieve adequate pulmonary blood flow and cardiac output in anesthetic management. In this case, a 10-year-old boy (19.6 kg, 114 cm) with cleft palate, cerebral palsy and severe mental retardation, who underwent a Fontan operation when he was 4 years old, was presented for deep sedation. Because he was suffering from eating disorder with cleft palate, the orthodontist and the plastic surgeon planned to insert intraoral orthodontic device before cleft palate repair. But it was impossible to open his mouth for alginate impression procedure. After careful pre-anesthesia evaluation we planned to administer deep sedation with propofol infusion. After Intravenous catheter insertion, we started propofol intravenous infusion with the formula of a loading dose of 1.0 mg/kg followed by an infusion rate of 6.0 mg/kg/hr with syringe pump. His blood pressure was remained around 80/40 mmHg after loss of consciousness, but he could not maintain his airway patent. So we lowered the infusion rate to 3.0 mg/kg/hr, immediately. The oxygen saturation was maintained above 95% with nasal oxygen supply, and blood pressure was maintained around 100-80/60-40 mmHg. After the sedation of 110 minutes with propofol (the infusion rate to 3.0-5.0 mg/kg/hr), he fully regained consciousness, and was discharged without complication after 1 hour observation. In case of post-Fontan patient, intravenous deep sedation with propofol was safe and effective method of behavioral management during dental treatment.

성대구증 및 성대 반흔 환자에서 주사후두성형술의 효과 (Injection Laryngoplasty for The Treatment of Vocal Fold Scar, and Sulcus)

  • 우주현;백민관;김동영;박형민;안상희;문광하;차흥억
    • 대한후두음성언어의학회지
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    • 제27권1호
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    • pp.25-29
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    • 2016
  • Background and Objectives : The clinical reports for the treatment of vocal fold scar and sulcus vocalis are limited, also there is no best one for the treatment of them. This study is to evaluate the effect of Injection laryngoplasty (IL) for the treatment of vocal fold scar and sulcus vocalis. Materials and Methods : from January 2013 to May 2015, the Nineteen patients who were diagnosed as vocal fold scar, sulcus and atrophy, and underwent IL, were engaged in this study. Clinical information and voice parameters were analyzed by retrospective chart review. Pre and post voice parameters were compared. Results : Subgroups of diagnosis were classified into sulcus vocalis for 12 patients, vocal fold scar for 5, and atrophy for 2. IL was performed under local anesthesia through cricothyroid membrane except one patient. Atesense$^{(R)}$, Radiessess$^{(R)}$, and Rofilan$^{(R)}$ were used as injected materials in 9, 9, and 1 patients respectively. Maximal phonation time (p=0.0124), dynamic range (p=0.0028), pitch range (p=0.0141), voice handicap index (p=0.028), glottal closure (p=0.0229), and mucosal wave (p=0.0132) had significant improvement for post-IL voice assessment than Pre-IL. While GRBAS, Mean flow rate, Jitter, Shimmer, Harmony to Noise ratio didn't have improvement. Conclusion : IL is a feasible option for the treatment of glottis incompetence with normally mobile vocal folds such as sulcus vocalis and vocal fold scar.

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Reduced Port Surgery for Prostate Cancer is Feasible: Comparative Study of 2-port Laparoendoscopic and Conventional 5-port Laparoscopic Radical Prostatectomy

  • Akita, Hidetoshi;Nakane, Akihiro;Ando, Ryosuke;Yamada, Kenji;Kobayashi, Takahiro;Okamura, Takehiko;Kohri, Kejiro
    • Asian Pacific Journal of Cancer Prevention
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    • 제14권11호
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    • pp.6311-6314
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    • 2013
  • Background: While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each. Materials and Methods: From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain. Results: There was a significant difference in operative time between the 2-port RP and LRP groups ($286.5{\pm}63.3$ and $351.8{\pm}72.4$ min: p=0.0019, without any variation in blood loss (including urine) ($945.1{\pm}479.6$ vs $1271.1{\pm}871.8ml$: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance ($5.6{\pm}1.8$ vs $8.0{\pm}5.6$ days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP. Conclusions: Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

자가 슬괵건을 이용한 전방 십자인대 재건술시 경골측 골 터널내 고정의 의의 (이차관절경 검사의 평가) (Significance of tibial intra-tunnel fixation at Arthroscopic ACL Reconstruction with hamstring tendon (Second-look Arthroscopic Evalution))

  • 김영창;서승석;정경칠;곽희철;김윤준;김진석
    • 대한관절경학회지
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    • 제10권2호
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    • pp.165-172
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    • 2006
  • 목적: 자가 슬괵건을 이용한 관절경하 전방십자인대 재건술시 이식건의 경골측 골 터널내 고정의 유용성을 이차 관절경 검사의 추시 관찰을 통하여 평가 하고자 하였다. 대상 및 방법: 1999년 12월부터 2005년 5월까지 자가 슬괵건을 이용한 전방 십자인대 재건술을 시행한 환자 중 이차 관절경 검사를 시행한 32례를 대상으로 하였다. 경골측의 고정방법에 따라 나사못 실고정만을 시행한 군(제 1군)과 나사못 실고정과 간섭나사를 이용한 경골측 골 터널내 고정을 함께 시행한 군(제 2군)으로 구분하였다. 이차 내시경 추시 관찰시의 평균 나이는 30세였으며 남자가 30례, 여자가 2례였고 전방십자인대 재건술 후 이차 관절경 검사를 시행한 기간은 평균 21.3개월이었다. 결과는 마취하의 KT-1000 관절계와 IKDC 분석 및 경골측 골 터널의 크기와 Telos 스트레스 부하 검사를 방사선학적으로 평가하였으며, 이차 관절경 소견의 평가 또한 시행하였다. 결과: 평가한 IKDC분석 및 Telos스트레스 부하 방사선 검사상의 전이 정도와 KT-1000 관절계상의 전이정도는 제2군에서 우수한 소견을 보였으나, 통계적으로 의미 있는 차이를 보이진 않았다. 관절 내시경상의 이식건의 긴장도, 이식건의 육안 소견, 이식건의 활액막 증식 정도도 제2군에서 우수한 소견을 보였으나, 통계적으로 의미 있는 차이를 보이진 않았다. 전후면 방사선 사진상 경골측의 골터널의 확장은 제1군에서 2.3 mm 및 제2군에서 1.7 mm로 측정되어 통계적으로 의미 있는 차이를 보였다(P=0.042). 결론: 자가 슬괵건을 이용한 십자 인대 재건술에서 경골측 골 터널내 고정의 부가하는 시술은 경골측 골터널의 확대를 의미 있게 감소 시켰으나 수술 후의 임상적 결과, 관절의 동요 정도, 관절경적 소견에 있어 유의한 차이는 보이지 않았다. 본 연구에서 경골측 고정을 위해 나사못 실고정 단독으로 사용하여도 만족스러운 임상적 결과, 관절의 안정도, 이식건의 성숙을 얻을 수 있었고 경골측 골터널의 확대는 결과에 영향을 미치지 않는다는 것을 알 수 있었다.

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대퇴경부 골절 환자의 입원 생활 (The Hospital Life of the Patient with Femoral Neck Fracture)

  • 김경자;지성애
    • 간호행정학회지
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    • 제2권1호
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    • pp.35-56
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    • 1996
  • Nowerdays, the increase of traffic accidents and old age population make the Femoral Neck Fracture(FNF) patients increase. By the improvement of education and standard of living the patients demand better medical service than before. This study is designed to give practical help for the FNF patients by observing their hospital life and establish practical nursing strategies for the FNF patients. For these purposes the Ethnographic Participant Observation was adopted. By this study is focused on the hospital life patient's view. For this end, the field study adopted orthopedic ward in the C University Hospital with 400 beds in Seoul. The object patients of the study were twelve patients. The patients experienced five stages : Embarrassment, Conflict, Stability, Independent, and Extension Stage. The findings and prepared nursing strategies are stated as follows. First, in the Embarrassment Stage they suffered embarrassment, anxiety, pain, they could not do ordinary things. The patients who accidental fractures had anxiety from unfamiliar tests and from hospitalization itself. They lamented that they could not ordinary things, and do nothing but obeying the hospital, and endure the pain. They recognized the changed environment and resigned themselves to life in the ward. In this stage, full openness by the nurses is needed. Second, the attribute of the Conflict Stage were conflict, fear, curiosity, belief, reflection. When they sign the consentment form, they experience conflicts about the possibility of complication, fear of recovery from anesthesia, curiosity about the operation procedure, post - operation state, reflection on their past life, and promise to care for their family members after discharge and keep their religious life faithfully. And they accepted the operation depending on God, believing in modern medicine, and the surgeon. Asking for their changed informations, they expected positive results from the operation. In this stage, an empathic attitude by the nurses is needed. Third, the attribute of the Stability Stage were relief, gratitude, difficulty with excretion, and pain. When they awoke from anesthesia, they felt relief because of a the end of the operation, but they experienced extreme pain, difficulty of excretion in bed. They accepted the changed environment and expected recovery. In this stage, support by the nurses is needed. Fourth, the attributes of the Independence Stage were freedom, exercise, nurturing, anxiety, and discomfort. When they ambulated and exercised, they experienced freedom. They showed exhibited weakness of the digestive organs and discomfort hospital's space, structure, and facilities, the delay of medical certificate issue the lack of prompt response by the medical agents. They ate nurturious food and felt anxiety on the end of hospital life and returning to their ordinary life. They showed the independence of overcoming their environment by increasing exercise and expected their discharges. In this stage, respect by the nurses is needed for the patients to, overcome their environment and prepare for their independence. Fifth, the attributes of the Extension Stage were pessimism, isolation, dissatisfaction, and pain. Accompanied injury and old age made their ward life extend to over seven weeks. They exhibited weariness, melancholy, skeptisis, general pessimistic feeling, and desperation caused by their isolated life. They experienced the digestive discomfort caused by the prolonged medication and psycological pain caused by long-time hospitalization. As a, result, their dissatisfaction on the human, physical, and systematic environments had been increased. They acquired critical power and sought for something to do spending their time. They expected vaguely about the returning of their ordinary life. In this stage, counseling is needed by the nurse to overcome positively their psychological, social, and physical problems. The process of the FNF patient's ward life starts from the dependent state, when they are hospitalized, and gradually progresses to self-fulfillment in order to keep independent life. As a result, the FNF patients showed "Response in Challenge" or "Adaptation in Conflict" through their experiences of social, physical, and psychological difficulties.

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태아양 모델을 이용한 실험적 태아 심폐우회술 (Experimental Fetal Cardiopulmonary Bypass in the Fetal Lamb Model)

  • 이정렬;임홍국;김원곤;김종성;최정연;김용진
    • Journal of Chest Surgery
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    • 제32권6호
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    • pp.495-503
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    • 1999
  • 배경: 본 연구에서 저자 등은 태아양 모델을 이용하여 태아 심폐우회술의 기술적인 측면에서의 가능성을 실험하고 심폐우회술과 관계된 태아의 혈역학과 태반기능에 관한 기초자료를 얻고자 하였다. 대상 및 방법: 제태기간 120~150일 되는 11마리의 태아양을 이용하여 정중흉골절개하에 주폐동맥과 우심이에 각각 12 G, 14~18 F 크기의 도관을 삽관하여 30분 동안 심폐우회술을 시행하였다. 어미양은 케타민 정주를 이용한 전신마취를 시행하였고 태아양에 대하여는 근육이완제만을 사용하였다. 실험군을 롤러펌프와 인공 막성산화기(Micro-safe, Polystan 회사제, 덴마아크)를 이용한 군(8마리, 산화기군)과 바이오펌프(Bio-pump, Bio-Medicus 회사제, 미국)와 태반을 산화기로 이용한 군(3마리, 태반군)으로 이분하여 혈류, 태아 혈역학 및 태반기능을 관찰하였다. 결과: 태아양의 평균체중은 3.6$\pm$1.3(1.9~5.2) kg이었다. 산화기군에서 심폐기 가동 중에는 평균동맥압 69.8~82.6 mmHg, 평균동맥혈산소분압치 201.7~220.9 mmHg, 평균심방압 4.1~4.3 mmHg, 평균심박동수 169~182 /min, 평균혈류 140.3~164.0 ml/kg/min로 유지되었으나 체외순환을 정지하는 순간부터 급격한 심기능 및 가스소견의 악화가 관찰되어 평균동맥압 29.0~57.4 mmHg, 평균동맥혈이산화탄소분압치 61.9~77.1 mmHg 등이었다. 태반군에서는 심폐우회 시작 직후 평균 44.7 mmHg에서 14.4 mmHg로 급격한 혈압 강하가 관찰되었고 이때 혈류는 평균 74.3~97.0 ml/kg/min 였다. 가스소견 역시 평균동맥혈이산화탄소분압치와 pH가 각각 평균 61.9~129.6 mmHg, 6.7~6.8이었으며 체외순환 정지후에는 심실세동으로 혈역학 측정이 불가능하였다. 결론: 연구자 등은 본 연구를 통하여, 비록 태아의 장기생존을 위한 태아 혈역학의 유지 및 태반혈류의 확보에는 어려움을 겪었으나 양모델을 이용한 실험적 태아 심폐우회술을 시도하여 태아 심장수술의 기술적인 측면에서의 가능성을 확인하였다. 향후 프로스타글란딘 억제제의 추가, 태아에 전척추마취의 적용, 펌프의 개선 및 순환회로의 축소화 등의 수정된 태아 체외순환에 관한 연구가 계속되어야 할 것으로 사료된다.

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