기관지 차단기를 사용한 폐엽절제술 후 발생한 종양 덩어리에 의한 기도 폐쇄 -증례 보고-

이귀용,이귀용,정락경,김윤진,김치효,김동연,김관창 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4

Dislodgement of tumor fragment with airway obstruction in a dependent bronchus can be a cause of severe hypoxemia, which is a rare but very serious complication of lung surgery. We describe a case of airway obstruction following deflation of a balloon of a bronchial blocker of a Univent tube during right bilobectomy. Following reintubation with a single lumen tube, the patient was simultaneously extubated with the biopsy forceps holding the mass. This report underlines that anesthesiologist should be alert to a possibility of airway obstruction following deflation a balloon of a bronchial blocker.

Severe Hypocalcemia Caused by Absorption of Sorbitol-Mannitol Solution during Hysteroscopy

이귀용,한종인,허현주 대한의학회 2009 Journal of Korean medical science Vol.24 No.3

Hysteroscopic procedure can be complicated by intravascular absorption of irrigating fluid. The clinical features of this complication are similar to transurethral resection of the prostate (TURP) syndrome. There have been few reports on hypocalcemia during endoscopoic surgery and clinical implications of hypocalcemia in TURP syndrome have been underestimated. We report a case of TURP syndrome association with a decreased ionized calcium concentration of 0.53 mM/L after the absorption of a large amount of sorbitol-mannitol solution during hysteroscopy. The hypotension which occurred in TURP syndrome did not respond to vasopressor and inotropic agent but responded to the administration of calcium. This case was also accompanied by hyponatremia, hyperglycemia and lactic acidosis through the metabolism of sorbitol.

65세이상의 노인환자에서 술전 폐 가스교환의 평가

이귀용 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.4

목적: 노화에 의한 호흡계변화로 환기량 및 가스교환 기능의 감소가 나타난다. 본 연구에서는 폐질환이 없으며 전신 상태가 양호한 노인환자의 술전 동맥혈 산소분압을 측정 하여 연령과 동맥혈 산소분압의 관계 및 노화에 의한 폐포 가스교환 상태를 평가하였다. 방법: 미국마취과학회 신체분류상 1, 2급에 해당하는 65세 이상의 환자 106명과 21~60세의 환자 40명을 대상으로 하여 술전 대기호흡 상태에서 동맥혈을 채취한 후 ABL520(Radiometer. Denmark)을 사용하여 가스분석을 실시하였다. 측정한 동맥혈 산소분압과 이산화탄소분압으로 폐포 산소분압과 폐포 - 동맥혈간 산소분압차 및 동맥혈/폐포 산소분압율을 계산하였다. 결과: 노인환자군의 동맥혈 산소분압과 폐포-동맥혈간 산소분압차는 대조군에 비해 유희하게 감소되었다. 이산화탄소분압 및 폐 산소분압은 대조군과 유사하였다. 연령과 동맥혈 산소분압과의 관계는 Y=103.6-0.332×(연령)이었다. 결론: 동맥혈 산소분압은 연령증가에 따라 유의하게 감소하였으며 노인환자의 동맥혈 산소분압은 넓은 범위에 분호하고 있었다. 노인환자에서는 동맥혈/폐포 산소분압율이 잘 유지되더라도 폐포-동맥혈간 산소분압차는 현저히 증가하므로 수술기주위의 산소화 감시 및 주의가 필요 하다고 생각한다. Objectives : As the number of elderly people rises, the incidence of surgery in elderly patients would become higher. This study was undertaken to examine the changes in pulmonary gas exchange that occurs with advancing age. Methods : Arterial blood gases were analysed in 106 elderly patients over the age of 65 and 40 adult patients(control group) during breathing of room air preoperatively. Alveolar oxygen partial pressure(PAO_2), alveolar-arterial partial pressure gradient for oxygen(AaDO_2), arterial/alveolar oxygen partial pressure(a/A) ratio were calculated using PaO_2 and PaCO_2 and PAO_2 and measured the relationship between the PaO_2 and age. Results : PaO_2 declined as age increased significantly and the regression equation was PaO_2=103.6 -0/332×age(r=0.55). There was no significant difference in PaCO_2 and PAO_2 but AaDO_2 increased and a/A ratio decreased significantly. Conclusions : As the AaDO_2 and a/A ratio were changed significantly, it is necessary for monitoring of oxygenation during perioperative periods in elderly patients.

급성 저산소증 흰쥐에서 Halothane 및 Enflurane이 간조직에 미치는 영향

이귀용 梨花女子大學校 韓國生活科學硏究院 1993 韓國生活科學硏究院 論叢 Vol.51 No.-

술중 Mannitol 투여가 혈청 삼투질농도 및 전해질에 미치는 영향

이귀용 梨花女子大學校 醫科大學 醫科學硏究所 1992 EMJ (Ewha medical journal) Vol.15 No.2

Mannitol is used to reduce brain volume and intracranial pressure. These effects facilitate the surgical approach to deep-lying structures of cranial cavity. Intraoperatively, mannitol is administered in dose ranges of 0.25~1g/kg. The administration of mannitol may cause adverse effects. such as; rebound of intracranial pressure, transient increases in circulating blood volume, increased serum osmolality and decreased serum electrolytes. This study examined the influence of 20% mannitol on serum osmolality and electrolytes in 24 patients undergoing brain tumor, cerebral aneurysm and intracerebral hemmorrhage surgery. Measurement were made before the infusion of mannitol. 15 minutes following infusion. after dural closure and in the ICU. There was a significant increase in serum osmolalitv after infusion of mannitol. There was a significant decrease .in serum Na^+ only 15 minutes following infusion. There was a significant decrease in serum K^+ 15 minutes postinfusion and dural closure. In conclusion, it is important to measure osmolality and electrolytes before and after infusion and adjust fluid administration.

제왕절개술환자에서 술후 Pancuronium 및 Vecuronium 의 잔류마비 효과 : Pancuronium vs. Vecuronium

이귀용 梨花女子大學校 醫科大學 醫科學硏究所 1991 EMJ (Ewha medical journal) Vol.14 No.4

Incomplete antagonism of competitive neuromuscular blockade is a potentially lethal complication in postoperative period. Assessment of recovery from nondepolarizing neuromuscular block has been based on clinical criteria such as; head lift, hand grip strength, adequate tidal volume, vital capscity and inspiratory force which mostly require a cooperative patient. Other criteria, indepent of patient cooperation have been the interpretation of evoked muscle responses to single twich, tetanic and train-of-four stimulation. The present prospective investigation compare the incidence of residual neuromuscular blockade using train-of-four responses following administration and reversal of pancuronium and vecuronium in obstetric patients. The results were as follows: 1) The mean TOF ratio(T_4/T_1) in pancuronium group was 0.75±0.05. 2) The mean TOF ratio(T_4/T_1) in vecuronium group was 0.85±0.04. 3) 50% of patients(10/20) in the pancuronium group evidenced a ratio below 0.7, 20% of patients(4/20) in the vecuronium group was evidenced a TOF ratio below 0.7. In conclusion, the present study emphasizes the potential for residual neuromuscular blockade in patients who received pancuronium. In contrast, patients administered vecuronium appear to have a grater margin of safty postoperatively.

Postoperative hypothermia in geriatric patients undergoing arthroscopic shoulder surgery

이귀용,천은희,김치효 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.1

Background: Hypothermia below 36°C is a common problem during arthroscopic shoulder surgery. Geriatric patients are more vulnerable to perioperative hypothermia. The present study compared postoperative hypothermia between geriatric and young adult patients receiving arthroscopic shoulder surgery. Methods: Data were collected retrospectively from a geriatric group (aged 65 or more, n = 29), and a control group (aged 19–64, n = 33) using the anesthesia records of patients who had undergone arthroscopic shoulder surgery. The primary outcome measure was the incidence of hypothermia upon arrival in the postanesthesia care unit (PACU). The secondary outcome measure was the decrease in body temperature from admission into the operating room to admission into the PACU. Results: The incidence of hypothermia was 93.1% and 54.5% in the geriatric and control groups, respectively, demonstrating a significant difference between the groups (P < 0.001). Comparison between body temperature revealed a decrease of 1.5 ± 0.6°C and 1.0 ± 0.4°C in the geriatric and control groups, respectively, showing a significant difference between the groups (P < 0.001). The degree of hypothermia was significantly different between the groups (P = 0.027). No shivering was observed in either of the two groups, but the incidence of thermal discomfort was higher in the geriatric group than in the control group (P = 0.021). Conclusions: In geriatric patients undergoing arthroscopic shoulder surgery, both the incidence of postoperative hypothermia and the associated temperature drop are more prominent than those in young adult patients. Additional warming methods will be needed to prevent postoperative hypothermia in geriatric patients.

선택수술이 예정된 노인환자에서 마취 전 평가의 임상적 의의

이귀용,정락경 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.5

임신 중 비산과적 수술을 위한 마취의 후향적 조사

이귀용 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.46 No.4

노인 환자에서 의식 진정에 필요한 Propofol 효과처 농도의 적정

이귀용 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.2