Hemodynamic management during off-pump coronary artery bypass surgery: a narrative review of proper targets for safe execution and troubleshooting

심재광,Kim Kwang-Sub,Couture Pierre,Denault André,곽영란,Yoo Kyung-Jong,Youn Young-Nam 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.4

Off-pump coronary surgery requires mechanical cardiac displacement, which results in bi-ventricular systolic and diastolic dysfunction. Although transient, subsequent hemodynamic deterioration can be associated with poor prognosis and, in extreme cases, emergency conversion to on-pump surgery, which is associated with high morbidity and mortality. Thus, appropriate decision-making regarding whether the surgery can be proceeded based on objective hemodynamic targets is essential before coronary arteriotomy. For adequate hemodynamic management, avoiding myocardial oxygen supply-demand imbalance, which includes maintaining mean arterial pressure above 70 mmHg and preventing an increase in oxygen demand beyond the patient’s coronary reserve, must be prioritized. Maintaining mixed venous oxygen saturation above 60%, which reflects the lower limit of adequate global oxygen supply-demand balance, is also essential. Above all, severe mechanical cardiac displacement incurring compressive syndromes, which cannot be overcome by adjusting major determinants of cardiac output, should be avoided. An uncompromising form of cardiac constraint can be ruled out as long as the central venous pressure is not equal to or greater than the pulmonary artery diastolic (or occlusion) pressure, as this would reflect tamponade physiology. In addition, transesophageal echocardiography should be conducted to rule out mechanical cardiac displacement-induced ventricular interdependence, dyskinesia, severe mitral regurgitation, and left ventricular outflow tract obstruction with or without systolic motion of the anterior leaflet of the mitral valve, which cannot be tolerated during grafting. Finally, the ascending aorta should be carefully inspected for gas bubbles to prevent hemodynamic collapse caused by a massive gas embolism obstructing the right coronary ostium.

한국군 군대윤리에 적합한 도덕이론에 관한 연구 -덕윤리를 중심으로-

심재광 육군사관학교 화랑대연구소 2017 한국군사학논집 Vol.73 No.3

이 글의 목적은 한국군 군대윤리의 기반이 되기에 적합한 도덕이론이 덕윤리임을 밝히고자 하는 것이다. 이를 위해 군대윤리로서의 공리주의와 의무론이 갖는 문제점을 살펴보고 덕윤리가 적합한 이유에 대해 살펴본다. 이러한 과정을 통해 의무론이나 공리주의는 법칙 중심적인 이론들이기 때문에 특정 상황에서 어떤 법칙이나 원칙에 의존에 결정을 내릴 수밖에 없고, 이런 법칙이나 원칙에 편향된 판단을 내릴 수 있음을 살펴본다. 또한, 이러한 특성으로 인해 각각의 상황이 가지는 특수성이나 맥락을 파악하여 예외적인 결정을 내리는 유연한 사고를 하기 힘들고, 해당 상황과 관련되어 있는 이해 당사자들의 이익을 고루 심사숙고하여 이들 간에 조화로운 균형점을 찾기 어려운 부분이 있다는 것을 밝힌다. 반면에 덕윤리적 입장에서는 행위자를 중심으로 각각의 상황이 가지는 특수성이나 맥락을 파악하여 예외적인 결정을 내릴 수 있는 유연한 사고가 가능하며, 해당 상황과 관련되어 있는 이해 당사자들의 이익을 고루 심사숙고하여 이들 간에 조화로운 균형점을 찾는 것이 가능하기 때문에 다른 이론들보다 한국군 군대윤리의 기반이 되기에 더욱 적합함을 보일 것이다. The purpose of this study is to find out that the virtue ethics is an appropriate moral theory for being a foundation of military ethics of Korean army. To this end, I will examine the problems of utilitarianism and deontology as military ethics and find out why the virtue ethics is more suitable. First of all, I will show that because utilitarianism or deontology are law-centric theories, we cannot help deciding base on certain laws or principles and therefore we could make biased decisions in these certain laws or principle. And I will show that due to these features it is hard to make a flexible thinking which enables us to make exceptional decisions by comprehending distinct characteristics or contexts of situations, and they also make it more difficult to find a Harmonious Balance between them through contemplating on benefits of people related with the situations. On the other hand, from the perspective of virtue ethics, it is possible to make flexible thinking based on the special characteristics or circumstances of each situation. And it is also possible to consider the benefit of each party related to some situations. For these reasons, it would be more suitable than other theories for the base of military ethics of Korean army.

다중 신호원 빔형성에서 새로운 신호원의 도래방향 추정 ( DOA Estimation of New Appearing Source in Multisource Beamforming )

심재광,강성현,윤원식 대한전자공학회 1998 대한전자공학회 학술대회 Vol.1998 No.1

Effects of Sensorimotor Training Volume on Recovery of Knee Joint Stability in Patients following Anterior Cruciate Ligament Reconstruction

심재광,최호석 대한물리치료학회 2016 대한물리치료학회지 Vol.28 No.1

Purpose: The purpose of this study is to examine the effects of sensorimotor training on knee joint stability after anterior cruciate ligament reconstruction. Methods: The subjects were sixteen 16 adults who received anterior cruciate reconstruction by arthroscopy, and underwent sensorimotor training for which was to have them maintenanceain of a standing position with a step Balance ball on the affected side over 30 degrees knee flexion with 100% weight bearing for 15-20 seconds. Before the genuine experiment commenced, the Lysholm scale was had been used to assess functional disorders on the affected knee joint. KT-2000 Arthrometer measurement equipment was used to measure anterior displacement of tibia against to femur before and after the sensorimotor training. Results: There was significant relaxation on the affected side in tibia anterior displacement of the affected and sound sides on in supine position before the sensorimotor training. There was little significant difference in tibia anterior displacement of the affected knee joints on in the supine position before and after the sensorimotor training. The results also showed that there was a reduction in the difference of tibia anterior displacement of the affected knee joints on in the standing position. These results suggest that the effects of sensorimotor training on knee joint stability after anterior cruciate ligament reconstruction is to induce the change of tibia anterior displacement against femur and the variation of muscles activation. Conclusion: The sensorimotor training may contribute to the improvement of joint functional stability in people who are in post-operation state and with orthopedic musculoskelectal injuries.

A Study on the Features and Critiques of Rawls’ Original Position

심재광 대한철학회 2020 哲學硏究 Vol.155 No.-

Based on social contract theory, Rawls introduces hypothetical situations to derive the principles of justice that everyone can agree on. And some conceptual tools are used within these hypothetical situations to find the universal and coherent principles of justice that can be agreed upon in any case. The purpose of this paper is to examine the characteristics and problems of hypothetical situations named ‘the original position’ which is introduced by Rawls to elicit these principles of justice and ‘the veil of ignorance’ used in the original position to get interested parties to reach an agreement. At the same time, this article will look into the features and problems of ‘the maximin rule’. Rawls said that individuals in the original position will choose the maximin rule because they are laid in the veil of ignorance and do not know specific information about themselves, as well as individuals in the original position are risk aversion people. However, in the hypothesis there are several problems.

' System 기법 ' 을 적용한 도심형 인쇄소 건축계획에 관한 연구

심재광,박길용 대한건축학회 1998 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.18 No.2

Effect of Intracoronary Shunt on Right Ventricular Function During Off-pump Grafting of Dominant Right Coronary Artery with Poor Collateral

심재광,방서욱,이종화,오영준,유경종,곽영란 대한의학회 2008 Journal of Korean medical science Vol.23 No.3

Although numerous studies have validated the efficacy of intracoronary shunt on reducing left ventricular dysfunction during off-pump coronary artery bypass surgery (OPCAB), there is lack of evidence supporting its role on right ventricular (RV) function during right coronary artery (RCA) revascularization. Therefore, we studied the effect of intracoronary shunt during grafting of dominant RCA without visible collateral supply on global RV function using thermodilution method. Forty patients scheduled for multivessel OPCAB with right dominant coronary circulation without collateral supply confirmed by angiography were randomized to RCA revascularization either with a shunt (n=20) or soft snare occlusion (n=20). RV ejection fraction (RVEF) was recorded at baseline, during RCA grafting, and 15 min after reperfusion. Corresponding RV stroke work index (RVSWI) was calculated. RVEF and RVSWI decreased significantly during RCA grafting and returned to baseline values after reperfusion in both groups without any significant differences between the groups. Intracoronary shunt did not exert any beneficial effect on global RV function during RCA grafting, even in the absence of visible collateral supply. Regarding the possibility of graft failure by intracoronary shunt-induced endothelial damage, routine use of intracoronary shunt during RCA grafting is not recommended in patients with preserved biventricular function.

심방세동 환자에서 class Ic 항부정맥제 사용중 발생한 wide QRS 빈맥2예 : Report of 2 Casses

심재광,이동일,김종현 침례병원 2003 浸禮病院學術誌 Vol.19 No.-

덕윤리적 관점에 기반 한 실천적 군대윤리 교육의 가능성에 대한 고찰

심재광 육군사관학교 화랑대연구소 2019 한국군사학논집 Vol.75 No.1

이 논문의 목적은 덕윤리적 관점에 기반 한 실천적 군대윤리 교육의 가능성을 보이고 이를 위해 실제 교육 현장에 적용될 수 있는 하나의 교육 모델을 제시하는 것이다. 이를 위해 우선 윤리학이 실천학임을 보이고 군대윤리 역시 하나의 응용윤리로써 실천학 이어야함을 보였다. 이어서 이렇게 아는 것을 실천하도록 만들어야 하는 군대윤리 교육이 실제로는 이성적 판단 능력을 높이는 방향으로 교육되어 왔음을 보이고 실천적 군대윤리 교육이 왜 중요한지 살펴보았다. 다음으로 실천적 군대윤리 교육이 덕윤리적 관점을 기반으로 가능함으로 보이고 이러한 가능성을 하나의 모델로 보였다. 이 모델은 모두 4단계로 구성되어 있다. 1단계는 1-1단계와 1-2단계로 구분되는데, 1-1단계는 덕과 덕스러운 사람의 개념을 정립하는 단계이며 1-2단계는 그러한 개념에 부합하는 이상적인 모델을 찾는 단계이다. 2단계는 이상적인 모델과 같은 사람이 되기 위해 필수적으로 갖춰야 할 덕목을 찾는 단계이다. 3단계는 필수적으로 갖춰야 할 덕목을 습관화시킬 수 있는 방안을 강구하여 실천하고 기록하는 단계이다. 마지막 4단계는 지금까지 수행했던 것들의 결과를 분석하고 다른 사람들의 것과 비교·분석하여 피드백 하는 단계이다. The purpose of this paper is to show the possibility of practical military ethics education based on the virtue ethical perspective and to suggest this possibility as an educational model that can be applied to actual education field. To do this, this paper showed that ethics is a praktike, and that military ethics is also a praktike as an applied ethics. In addition, this study insisted that military ethics education, which should be made someone to act, has been educated in the direction of enhancing rational judgment ability. Secondly, this article showed that practical ethics education which is based on virtue ethical perspective is possible, and suggested this possibility as an education model. This model consists of four stages. The first step is divided into steps 1-1 and 1-2. Step 1-1 is the step of establishing the concept of virtue and virtuous person. Step 1-2 is the step of finding an ideal model that matches those concepts. Step 2 is the step of finding the virtues that are essential to being the ideal model. The third step is the step of finding a habituation method of the essential virtues, acting, and recording. The last step is the step to analyze the results of what you have done so far, to compare the results with other students, and to feedback.

신경계 재활의 전통적 중재와 대안적 중재 방법에 대한 문헌 고찰

심재광,최호석 한국신경근육물리치료학회(구 한국신경근육재활학회) 2015 한국신경근육재활학회지 Vol.5 No.1

This paper is a review conducted to provide an overview of the history of the past and contemporary rehabilitation methods for patient with damaged central nerves. Neurorehabilitation is a complex medical process which an aim to facilitate a recovery from a nervous system injury, and to minimize and/or compensate for functional impairments arising from it. By focusing on all aspects of a person's wellbeing, neurorehabilitation offers a series of therapies from the psychological to occupational, teaching or re-training the patients on mobility skills, communication processes, and other aspects of that person's daily routine. Current viewpoint represents a paradigm shift in clinical intervention, and clinicians have differently considered the details of intervention for the nervous and musculoskeletal impairments. Such concepts require to see the overall history of physical therapy, we interpreted the hidden meaning in the history of physical therapy. The current and future physical therapists will be to look at the patients as a comprehensive perspective. Medical instruments have continuously been developed. However, it may not be competed by senior physical therapists working for a long time in rehabilitation field. It’s probably useless to find only a way to treat a variety of patients with neurological impairments, representing optimal effects of rehabilitation, because definite answer to the therapy does not exist and their symptoms should be handled case-by-case. Thus, we need to take the advantages of functional evaluation, and they will be integrated into intervention.