• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제25권4호
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• pp.367-370
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• 1999

While oral and maxillofacial surgery such as orthognathic surgery, TMJ surgery is in progress, there always exists a risk of bleeding from maxillary artery, and this perplexes the surgeon in operation. In case of massive bleeding, it is mostly very difficult or even impossible to take an immediate action in order to stop bleeding. Even when hemostasis is possible by applying such methods as the use of local hemostatics, pressing, electrocoagulation or direct ligation, there is a high risk of secondary bleeding. Therefore, in case there is bleeding from maxillary artery, it is the best to restrain bleeding completely either by the ligation of the artery in bleeding in operation fields or by the ligation of the external carotid artery.

• Journal of Chest Surgery
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• 제31권6호
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• pp.581-585
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• 1998

술후자가수혈은 수혈부작용없이 혈액보존을 할 수 있는 방법으로 알려져있다. 불안정성 협심증에 대한 관상동맥우회술 후에 술후자가수혈을 채용하면 동종수혈을 얼마나 줄일 수 있을 지를 알아보고자 이 환자군을 대상으로 출혈경향과 동종수혈양상을 관찰하였다. 1997년 8월부터 10월까지의 기간에 시행한 관상동맥우회술 환자 중, 불안정성 협심증인 26명을 대상으로 후향적으로 조사한 결과 90%의 환자가 평균 2.4단위의 동종수혈을 받았고 85%의 환자에서 수술당일 중환자실에서 혈액이 투여되었으며 다수에서 빈혈의 교정이 아니고 혈량유지를 위하여 수혈이 이루어졌다. 출혈은 술후 5시간까지 평균 340cc였고 69%(18명)에서 200cc이상의 출혈을 보여 이 환자에게 자가수혈을 할수 있을 것으로 사료되었다. 결론적으로 여러 가지 혈액보존법의 채용에도 불구하고 90%의 환자에서 동종수혈이 이루어졌으며 그 중 다수에서 불필요한 수혈이 있었음을 알 수 있었으며 이를 해결하는 한 방법으로 수술직후 출혈이 있는 시기에 어떤 종류의 혈액이 필요하며 따라서 수술후 자가수혈을 채용하면 동종수혈을 줄이는데 기여할 수 있을 것으로 보인다.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.262-270
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• 2015

Objective : Long-term oral anticoagulation or antiplatelet therapy has been used with increasing frequency in the elderly. These patients are at increased risk of morbidity and mortality from expansion of intracranial hemorrhage. We conducted a single-center retrospective case control study to evaluate risk factors associated with outcomes and to identify the differences in outcome in traumatic brain injury between preinjury anticoagulation use and without anticoagulation. Methods : A retrospective study of patients who underwent craniotomy or craniectomy for acute traumatic cerebral hemorrhage, between January 2005 and December 2014 was performed. Results : A consecutive series of 50 patients were evaluated. The factors significantly differed between the two groups were initial Prothrombin Time-International Normalized Ratio, initial platelet count, initial Glasgow Coma Scale score, and postoperative intracranial bleeding. Mean Glasgow Outcome Scale (GOS) score were similar between the two groups. In the patient with low-energy trauma only, no significant differences in GOS score, postoperative bleeding and many other factors were observed. The contributing factors to postoperative bleeding was preinjury anticoagulation and its adjusted odds ratio was 12 [adjusted odds ratio (OR), 12.242; p=0.0070]. The contributing factors to low GOS scores, which mean unfavorable neurological outcomes, were age (adjusted OR, 1.073; p=0.039) and Rotterdam scale score for CT scans (adjusted OR, 3.123; p=0.0020). Conclusion : Preinjury anticoagulation therapy contributed significantly to the occurrence of postoperative bleeding. However, preinjury anticoagulation therapy in the patients with low-energy trauma did not contribute to the poor clinical outcomes or total hospital stay. Careful attention should be given to older patients and severity of hemorrhage on initial brain CT.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권6호
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• pp.575-582
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• 2021

Background: The aim of this randomized, triple-blind trial was to determine the anesthetic, analgesic, and hemodynamic effects of articaine and bupivacaine in the extraction of impacted mandibular third molar teeth. Methods: Twenty-six patients who underwent removal of bilaterally symmetric mandibular third molars were randomly assigned to articaine and bupivacaine groups in a split-mouth design. The onset of anesthetic action, intraoperative comfort, total amount of solution used, duration of postoperative anesthesia and analgesia, rescue analgesic use, postoperative pain, intraoperative bleeding, and hemodynamic parameters were evaluated. Results: In the articaine group, the onset of anesthetic activity was faster, intraoperative comfort was greater, and effective anesthesia required less local anesthetic solution. The bupivacaine group showed a significantly longer duration of postoperative anesthesia and analgesia, in addition to lower visual analog scale values at 6 and 48 hours postoperatively. There were no significant differences between the two solutions regarding rescue analgesic medication use, intraoperative bleeding, or hemodynamics. Conclusion: Articaine showed greater clinical efficacy than bupivacaine in intraoperative anesthesia, achieving faster onset of anesthetic action and greater patient comfort while also requiring less reinforcement during surgery. However, bupivacaine was superior in terms of postoperative anesthesia, reducing postoperative pain due to its residual anesthetic and analgesic effects. Both anesthetic solutions led to similar hemodynamics at low doses in mandibular third molar surgery

• 생명과학회지
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• 제18권11호
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• pp.1493-1498
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• 2008

본 연구는 심폐바이패스를 이용한 성인 심장수술 시 수술 후 환자의 회복 결과에 영향을 미치는 인자들을 규명하기 위해 시행하였다. 성인 심장수술 환자 32명을 대상으로 하여 연구하였다. 심장수술 시 밸혈구 수, GOT, troponin-I (cTNI), interleukin-6 (IL-6), endothelin-1 (ET-1), D-dimer, neuron-specific enolase (NSE) 등의 혈장농도는 유의하게 증가한데 비해 혈소판 수는 감소하였다. 수술 직후 GOT 및 D-dimer 농도와 24 시간 및 총출혈량, 기계호흡보조 시간, 중환자실 치료기간, 재원일수와 각각 양의 상관성이 있었다. 혈소판 수와 기계호흡보조 시간, 중환자실 치료기간, 재원일수와 각각 음의 상관관계가 있었다. Creatinine 농도와 기계호흡보조 시간, 중환자실 치료기간 사이에 양의 상관성이 있었다. NSE 농도와 24 시간 출혈량 사이에 양의 상관관계를 보였다. cTNI 농도와 재원일수 간에 양의 상관성이 있었다. 대동맥 교차차단 및 총심폐바이패스 실시 시간과 24 시간 및 총 출혈량, 재원일수 사이에 양의 상관관계를 나타내었다. 결론적으로 본 연구의 결과들은 심폐바이패스를 적용한 성인 심장수술 시 수술 후 환자의 결과와 회복에 영향을 미치는 가장 중요한 변수는 수술 종료 직후(CPB-off)의 GOT, BUN, creatinine, D-dimer 등의 농도와 혈소판 수임을 시사하고 있다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권4호
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• pp.223-231
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• 2020

Background: The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. Methods: Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. Results: We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. Conclusion: The incidence of severe and post-extubation bleeding was significantly less with xylometazoline. Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.

• Journal of Chest Surgery
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• 제13권3호
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• pp.167-173
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• 1980

From 1976 through June 1980, 75 patients underwent Open heart operation at Korea University Hospital.Of the 75 patients, 39 were congenital heart cases and 36 were acquired heart disease cases. 39 cases of congenital heart disease were consisting of 16 T.O.F.,4 A.S.D., 10 V.S.D., 3 P.S., 1 P.D.A., 1 V.S.D. + Mi, 1 Truncus arteriosus, 1 Ebstein, 1 D.C.R.V., 1 Single ventricle. Among 36 valvular replacement cases, 18 cases of MVR, 3 cases of AVR, 6 cases of Double valve replacement, and 10 cases of Open Mitral commissurotomy, were performed. Postoperative mortality rate of congenital heart disease was 25.6% and that of acquired heart disease was 8.3%. Overall mortality rate of open heart surgery was 17.3%. Among 16 cases of postoperative death cases, 5 cases of autopsy were performed. Postoperative cause of death of our series were intracranial bleeding, pacemaker failure, low output syndrome, protamine anaphylaxis, bleeding, prosthetic valve embolism, C V A, miliary tuberculosis, hypothermia due to pump failure.

• Journal of Chest Surgery
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• 제31권1호
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• pp.32-39
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• 1998

체외순환에 의한 개심술시 술후 출혈을 줄이고 아울러 혈액제재 투여를 감소하기 위하여 여러병원에서 최근 수년간 aprotinin을 Hammersmith 요법에 준하여 고용량으로 투여해 오면서 위 약제의 부작용이나 경제적 비용도 함께 고려되어 오고있다. 특히 aprotinin은 신장에서 대사되기 때문에 다른 부작용보다 aprotinin이 미치는 신기능장애에 대하여서도 논의되고 있다. aprotinin을 저용량으로 투여하였을 때 그 지혈효과와 아울러 신기능에 미치는 영향을 조사하기 위하여 체외순환을 시행한 33 명의 환자를 각각 무작위로 실험군(16명)과 대조군(17 명)으로 나누어 전향적 연구를 시행하였다. 출혈 감소의 정도를 파악하기 위하여 혈중 혈색소와 혈소판수치 및 수술후 출혈량을 수술전, 수술후에 측정하였고, 신기능 장애정도를 파악하기 위하여 혈중 BUN과 creatinine, 그리고 뇨 creatinine, 총단백질량, albumin, 및 alpha-1-microglobulin 수치를 수술전후로 측정하였다. 수술직후 6 시간동안 출혈량은 대조군보다 aprotinin군에서 상당히 감소되어(406$\pm$303 ml vs 243$\pm$123 ml ; P = 0.037) 통계적으로 유의한 차이를 보였을 뿐만아니라 수술후 24 시간 동안 출혈량도 통계적으로 의미있게 감소되었다( 869$\pm$570 ml vs 494$\pm$358 ml ; P = 0.045). 뇨중 alpha-1-microglobulin/creatinine 이나 microalbumin/creatinine는 대조군에 비하여 aprotinin군에서 수술후에 증가되었으나 통계적으로 유의한 차이는 없었다 (수술후 3 일째 alpha-1-microglobulin/creatinine; 24$\pm$10 vs 55$\pm$23, microalbumin/creatinine ; 38$\pm$25 vs 56$\pm$19 ). 일반적인 다른 신기능지표상에서도 두 군에서 유의한 차이는 없었다. 본연구에서 aprotinin을 저용량으로 투여함으로써 개심술시 체외순환후 발생하는 출혈량을 줄일 수 있을 뿐만 아니라 신기능에 영향이 없었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권6호
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• pp.364-368
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• 2019

A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권4호
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• pp.303-308
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• 2010

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal and gastric aspiration and hypovolemic shock. Therefore, the rapid and correct bleeding control is very important for saving lives in the emergency room. Despite the conventional bleeding control methods of wiring (jaw fracture, wound suture and direct pressure), continuous bleeding can occur due to the presence of various bleeding disorders. There are five main causes for excessive bleeding disorders in the clinical phase; (1) vascular wall alteration (infection, scurvy etc.), (2) disorders of platelet function (3) thrombocytopenic purpura (4) inherited disorders of coagulation, and (5) acquired disorders of coagulation (liver disease, anticoagulant drug etc.). In particular, infections can alter the structure and function of the vascular wall to a point at which the patient may have a clinical bleeding problem due to vessel engorgement and erosion. Wound infection is a frequent cause of postoperative active bleeding. To prevent postoperative bleeding, early infection control using a wound suture with proper drainage establishment is very important, particularly in the active bleeding sites in a contaminated emergency room. This is a case report of a rational bleeding control method by rapid wiring, wound suture with drainage of a rubber strip & iodoform gauze and wet gauze packing, in a 26-year-old male cerebral palsy patient with active oral and maxillofacial bleeding injuries caused by a traffic accident.