증례보고 : 우측 개흉술 중 발생한 발작 심실상성 빈맥 환자의 전-후 전극 위치의 이극 심장율동전환 치료경험

이지희 ( Ji Heui Lee ),김진강 ( Jin Kang Kim ),이현도 ( Hyun Do Lee ),손동일 ( Dong Il Sohn ),이소영 ( So Young Lee ),이수남 ( Su Nam Lee ),장호조 ( Ho Jo Jang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2

A 54-year-old male patient with squamous cell carcinoma of lung was scheduled for right lower lobectomy. He had suffered from diabetes mellitus during 8 years, but his preoperative electrocardiogram was normal sinus rhythm. During right thoracotomy, 2 times of unstable paroxysmal supraventricular tachycardia (PSVT) appeared but returned to normal sinus rhythm by carotid sinus massage. But, third unstable PSVT was not controlled by adenosine and anterior - lateral paddle positioned biphasic cardioversion. We changed anterior-lateral paddle position to anterior-posterior paddle position. And PSVT terminated abruptly and changed to sinus rhythm. So we present a case of unstable PSVT during right thoracotomy and treated with anterior-posterior paddle positioned biphasic cardioversion. (Korean J Anesthesiol 2006; 51: 246~51)

증례보고 : Osler- Weber- Rendu 증후군 환자의 전신마취 경험

이수남 ( Su Nam Lee ),김진강 ( Jin Kang Kim ),손동일 ( Dong Il Sohn ),이지희 ( Ji Heui Lee ),이용석 ( Yong Seok Lee ),이소영 ( So Young Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3

Hereditary haemorrhagic telangiectasia (HHT), or Osler-Weber-Rendu syndrome is an autosomal dominant disorder characterized by recurrent epistaxis, mucocutaneous telangiectasias, and visceral involvement including arteriovenous malformations that may develop in any organ, especially in the lung, brain, liver and GI tract. Early screening and regular follow up of patients with HHT are important to minimize the risk of development of serious sequelae. We report a case of 46-year-old female patient who had "suspected HHT" and review the literature on this rare disease. (Korean J Anesthesiol 2007; 52: 363~6)

백서의 격리폐에서 L-NAME 와 Glibenclamide 전처치가 Propofol 의 저산소성 폐혈관 수축에 미치는 영향

이춘희,이지희,김성덕 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.5

심폐 체외순환시기의 일측성 기관지 경련

김진경,오용석,이지희 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.3

Severe bronchospasm at the termination of the cardiopulmonary bypass period is an unusual but dangerous complication of open-heart surgery. We report a case of severe unilateral bronchospasm detected at the end of the bypass period on the basis of high airway pressures with remarkable difficulties to deflate the right lung and it was relieved with bronchodilator therapy by intrapulmonary percussive ventilation. Fiberoptic bronchoscopic examination revealed unobstructed, free tracheobnncheal airway and capnographic finding was obstructive pattern. As in the previously published cases, the exact cause of bronchospasm remains unknown in our patient as well, but the possible causes of the bronchospasm are described.

Vecuronium 투여후 Mechanomyography, Electromyography 및 Accelerograph 에 의한 근이완 회복의 비교연구

손희정,박선우,이지희,조대순 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.5

As the use of muscle relaxants routinize in the clinical general anesthesia, the proper estimation of neuromuscular blockade and recovery is needed for the more safe anesthetic management. Three recording methods of measurement in recovery are available; measurement of the evoked mechanical responses (mechanography), measurement of the evoked electrical responses (electromyography), and measurement of the acceleration of the muscle responses. The purpose of this study was to evaluate the correlations among mechanomyographic, electromyographic and accelerographic responses during recovery from vecuronium induced neuromuscular blockade. 15 ASA class 1 adult patients were studied. Measurements were as follows: 1) Recovery time of T₁/T_c, of 25%, 50%, 75%, 90% and 100% in each device. 2) Recovery index in each device. 3) The values of T₁/T_c, in EMG and ACC corresponding ta that of MMG. 4) The values of TOF ratio in EMG and ACC corresponding to that of MMG. The results were as follows: 1) Recovery time of T₁/T_c, measured by MMG, EMG and ACC was similar. 2) Linear relationship was found between MMG T₁/T_c. and EMG and ACC. 3) Linear relationship was found between MMG T₄/T₁ and EMG and ACC. Therefore, it is concluded that these three neuromuscular transmission monitoring devices can be used interchangeably without any serious clinical problems.

중등증 파상풍 환자의 마취 경험

박선우,황규현,이지희 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.4

The mainstays in the management of tetanus are sedation with various anesthetic agents, spasmolysis and the securing of an adequate airway with wound debridment, administration of antibiotics, human antitoxin immunization. Therefore, the anesthesiologist play a great role in and make many attempt for this management. We recently experienced a patient(53-year old man) who had undergone amputation of right thumb for squamous cell carcinoma of skin a year ago, addicted to morphine sulfate for long period. This case was diagnosed as generalized moderate tetanus. Anesthesia for the disarticulation of right wrist was successfully performed under general balanced anesthesia with fentanyl, isoflurane, vecuronium and other anesthetic agents that were relatively devoid of cardiovascular effect and under attentive monitoring including peripheral nerve stimulator. But he died due to pneumonia and acute renal failure in spite of all supportive methods including mechanical ventilation during postoperative period.

수술후 노인 환자에서의 자가 통증 조절시 진통 효과와 수술후 인식 장애

김명원,정일영,이지희,장호조 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.6

Background : Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. Methods : Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. Results : Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analoe scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. Conclusions : The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function. (Korean J Anesthesiol 1999; 36: 1017∼1025)

각성하 굴곡성 기관지경을 이용한 경비 기관내 삽관시의 반응에 대한 Esmolol 의 효과

김진희,김지희,염광원,이지희,김창기 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.1

Background: It has recently been shown that esmolol provided consistent and reliable protection against increase in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation. This study was therefore designed to establish whether esmolol was as effective in controlling the responses to awake fiberoptic tracheal intubation as it was in controlling the responses to traditional intubation and to assess the effect of esmolol for conditions of intubation, sedation, respiratory system during fiberoptic laryngoscopy and intubation. Methods: Thirty patients, ASA physical status I - Il, scheduled for oral and maxillofacial surgery, were randomly assigned to receive preintubation dose of either fentanyl 100 μg(Group F) or fentanyl 50 μg and esmolol 100 mg(Group E). And during awake fiberoptic nasotracheal intubation, heart rate, systolic and diastolic arterial pressures, minimal peripheral oxygen saturation, sedation score, intubation condition and time were recorded. Results: There were noignificant differences in arterial blood pressures, sedation score, intubation condition and time. But the change of heart rate in Group E was significantly less at 1 minite and 2 minites after the start of tracheal intubation and in Group F, minimal peripheral oxygen saturation was significantly reduced and two patients in Group F were hypoxemic and apneic. Conehasions: The present results show that esmolol provides attenuation of the change of heart rate by awake fiberoptic nasotracheal intubation and minimize the risk of apnea and hypoxia due to combination of fentanyl with midazolam.