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임상연구 : 부인과 환자에서 낮은 복압(8 mmHg)과 통상적 복압으로 달리 기복 유도된 복강경 수술과 개복수술 중 체온조절 양상 비교
김덕경 ( Duck Kyoung Kim ),이경민 ( Kyoung Min Lee ),이가영 ( Ga Young Lee ),윤창룡 ( Chang Yong Yoon ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: It has been suspected that laparoscopic surgery exacerbates hypothermia to a greater extent than open surgery. Thus, this study was designed to compare the intraoperative thermoregulatory profiles of three different operative techniques: open surgery, low pressure (LP: 8 mmHg) or conventional pressure (CP: 13 mmHg) laparoscopic surgery. Methods: Forty five patients who were scheduled for radical hysterectomy were allocated to three groups, 15 in each group: group O (open surgery), group LP and group CP. Anesthesia was maintained with 2.5% sevoflurane. Intraoperative core temperature and forearm minus fingertip skin temperature gradients were measured at 15-min intervals during the first three hours. Vasoconstriction threshold was defined by the esophageal temperature at which the skin temperature gradient equalled 0°C. Results: All groups were comparable in terms of the characteristics of patients and preoperative body temperatures. Core temperatures and forearm minus fingertip skin temperature gradients were not significantly different among the three groups at all measurements. Thermoregulatory vasoconstrictions were observed in 6 of group O and 6 of laparoscopic surgical patients (4 patients from group LP and 2 patients from group CP). These 12 patients were divided into open (n = 6) and laparoscopic (n = 6) surgery group. There were no significant difference between the groups with regard to the vasoconstriction threshold and threshold time. Conclusions: Laparoscopic procedures with conventional insufflation pressure have similar profiles in terms of intraoperative thermoregulation, when compared to open surgery. Lowering insufflation pressure to 8 mmHg can not reduce the risk of intraoperative hypothermia. (Korean J Anesthesiol 2006; 51: 44~51)
단순모형실험에 의한 콘크리트충전 원형강관기둥·보 접합부의 내력에 관한 연구
김덕경(Duck Kyoung Kim),최성모(Sung Mo Choi),신일범(Il Beom Shin),엄철환(Chul Hwan Eom),김동규(Dong Kyu Kim),김덕재(Duck Jae Kim) 한국강구조학회 1995 韓國鋼構造學會誌 Vol.7 No.2
This paper provides the results of an experimental study performed on beam to Concrete Filled Circular Steel Column connections with external stiffener rings through the Simple Tension Method. A total of 21 beam to column connections are tested to investigate the effect on local failure on connections. Important parameters in this study are the width of the external rings and whether or not the external rings are welded to the circular column. The test results are summarized for the strength, stiffness and strain distribution of each connection. Also, the strength and stiffness of each connection on a column filled with concrete is compared with a similar connection on a column not filled with concrete.
증례보고 : 편측 성대마비가 동반된 극소저출생체중 미숙아의 서혜부 탈장 수술 시 척추마취 경험
김덕경 ( Duck Kyoung Kim ),여진석 ( Jin Seok Yeo ),오충식 ( Chung Sik Oh ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
In premature infants, the incidence of inguinal hernia has been reported to be 14-30%. It is generally accepted that inguinal hernia should be repaired as soon as possible, as the incidence of incarceration is higher in infant than in children. However, the risk of life-threatening apnea after surgery is significant in this age group. Spinal anesthesia in premature infants offer a safe alternative to general anesthesia, especially if intubation should be avoid because of coexisting disease. We present a case of successful spinal anesthesia for inguinal herniorraphy in a premature female infant at a postconceptual age 44 + 6 weeks weighing 2,620 g with coexisting unilateral vocal cord paralysis to illustrate technical details and feasibility of this technique even in very low birth weight (birth weight < 1,500 g) infants. (Korean J Anesthesiol 2006; 51: 252~6)
증례보고 : 중증 신생아호흡곤란증후군을 동반한 미숙아의 동맥관 개존증 폐쇄술의 마취 관리
조재훈 ( Jae Hun Cho ),여진석 ( Jin Seok Yeo ),권원경 ( Won Kyoung Kwon ),김덕경 ( Duck Kyoung Kim ),김혜경 ( Hae Kyoung Kim ),이경민 ( Kyoung Min Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Premature infants with respiratory distress syndrome may have clinically significant shunting through a patent ductus arteriosus (PDA). Left-to-right shunting through the PDA may lead to left ventricular volume overload and pulmonary edema. We present a case of perioperative management for severe respiratory distress syndrome in a premature infant who underwent surgical closure of PDA. Under general anesthesia, the infant was successfully managed by inhaled nitric oxide, high frequency oscillation ventilation with intermittent mandatory ventilation despite intermittent hypoxia. The operation was performed safely in the neonatal intensive care unit. (Korean J Anesthesiol 2006; 51: 495~8)
김종성,김덕경,민성원,박재현 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.6
Nesidioblastosis, persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a disorder characterized by diffuse pancreatic islet cell hyperplasia arising from the ductal epithelium. Patients usually present during the neonatal or infantile period with apnea, hypotonia, poor feeding, lethargy, or seizure. Despite of greater awareness, one in three has some degree of mental retardation by the time the diagnosis is made. The diagnosis is established by demonstrating high plasma insulin concentration during an episode of hypoglycemia. This hypoglycemia is initially managed medically, but these medical treatment modalities are failed in more than half of nesidioblastosis. Patient who failed to respond to optimal medical treatment should be referred for surgery early, if permanent neurologic damage is to be avoided. The surgical procedure of choice is near total pancreatectomy (95∼98% resection). We herein discuss the anesthetic management of a patient with nesidioblastosis who presented for near total pancreaectomy. (Korean J Anesthesiol 1997; 32: 1031∼1035)
초저온하 완전순환정지술을 이용한 우심방 혈전을 동반한 신세포암의 완전 절제술의 마취 관리
김한철,김덕경,함병문,최익현 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.1
Renal cell carcinoma is associated with inferior vena cava tumor spread in 4∼10% of cases and with extension of the tumor thrombus into the right atrium in less than 1% of cases. Because inferior vena caval involvement does not affect the ultimate survival in patients with nonmetastatic renal cell carcinoma, aggressive surgical resection is indicated. We experienced a case of complete tumor excision with radical nephrectomy and inferior vena caval and right atrial thrombectomy using adjunctive cardiopulmonary bypass(CPB) and deep hypothermic circulatory arrest(DHCA). During total circulatory arrest(TCA), we protected brain from ischemic insult using deep hypothermia, retrograde cerebral perfusion, thiopental, and high dose steroid. The patient recovered uneventfully except minor neuropsychiatric symptom for 3 weeks after operation. (Korean J Anesthesiol 1998; 35: 181∼185)