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Propofol의 청각뇌간반응과 뇌교 청신경핵 부위 절편에서의 시냅스후전류에 대한 효과 사이의 상관성 연구
강봉진 ( Bong Jin Kang ),김석곤 ( Seok Kon Kim ),이관우 ( Gwan Woo Lee ),권민아 ( Min A Kwon ),송재격 ( Jae Gyok Song ),안승철 ( Seung Chul Ahn ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Background: Although there have been reports showing the changes of the auditory brainstem response (ABR) waves by propofol, no detailed studies have been done at the level of brainstem auditory circuit. So, we studied the effects of propofol on the postsynaptic currents of the medial nucleus of the trapezoid body (MNTB)-lateral superior olive (LSO) synapses by using the whole cell voltage clamp technique and we compared this data with that obtained by the ABR. Methods: 5 rats at postnatal (P) 15 days were used for the study of the ABR. After inducing deep anesthesia using xylazine 6 mg/kg and ketamine 25 mg/kg, the ABRs were recorded before and after intraperitoneal propofol injection (10 mg/kg) and the effects of propofol on the latencies of the I, III, and V waves and the I-III and III-V interwave intervals were evaluated. Rats that were aged under P11 were used in the voltage clamp experiments. After making brainstem slices, the postsynaptic currents (PSCs) elicited by MNTB stimulation were recorded at the LSO, and the changes of the PSCs by the bath application of propofol (100 μM) were monitored. Results: We found small, but statistically significant increases in the latencies of ABR waves III and V and the interwave intervals of I-III and III-V by propofol. However, no significant changes were observed in the glycinergic or glutamatergic PSCs of the MNTB-LSO synpases by the application of propofol (100 μM). Conclusions: Glycinergic or glutamatergic transmission of the MNTB-LSO synapses might not contribute to the propofol-induced changes of the ABR. (Korean J Anesthesiol 2009;56:552~8)
예기치 못한 후두 입구 협착으로 인한 환기 부전 상황에서의 비디오 후두경의 유용성 1예
문정환,이선홍,강봉진,Moon, Jeong Hwan,Lee, Sun Hong,Kang, Bong Jin 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.2
Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using $C-MAC^{(R)}$ video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.
박일환 ( Eal Whan Park ),강봉진 ( Bong Jin Kang ) 대한의료커뮤니케이션학회 2021 의료커뮤니케이션 Vol.16 No.1
Difficult patients who meet in the clinic may have a negative effect on the patient’s clinical outcomes by leading to difficulties in history taking, relationship building, diagnosis and treatment. Factors that contribute to non-cooperative patients include physician factors, patient factors, environmental factors, and communication factors. In order to communicate with non-cooperative patients, efforts to prepare for interviews and build relationships, self-reflective attitudes, empathic listening, the use of preceptors or reflective teams, and the maintenance of identity as medical professionals should be emphasized. Multi-party conversations, including family members, may be difficult in patient interviews, and physician should check the emotional responses and expectations that families feel about patient care. Within a family, there are many hidden strengths that could become valuable resources for healing the patient. But they will most likely to come out when families are faced with challenges for which their present repertoire of responses seems inadequate. Health care providers can become a significant part of this process that can result in better patient care and rewarding relationships with families.
증례보고 : 척추마취 중 발생한 심정지에서 ECMO(Extracorporeal Membrane Oxygenation)의 사용
전대근 ( Dae Geun Jeon ),김석곤 ( Seok Kon Kim ),강봉진 ( Bong Jin Kang ),김희수 ( Hee Soo Kim ),서필원 ( Pil Won Seo ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
We experienced a case where extracorporeal membrane oxygenation ECMO was used for a cardiac arrest that occurred during spinal anesthesia. An 84-year-old man underwent total hip replacement surgery. The patient developed sudden cardiac arrest at around 40 minutes after the administration of spinal anesthesia. The cardiac arrest was difficult to manage with ordinary CPR (cardiopulmonary resuscitation) and went on to complete cardiac arrest. ECMO (venoarterial ECMO from the right femoral artery to the right femoral vein) was immediately applied while performing cardiac massage. Heparin was infused with ACT (activated coagulation time) monitoring during ECMO. We also found multiple rib fractures and hemothorax resulting from the chest massage as seen on a chest X-ray. On the third day after resuscitation, communication with the patient was possible. Hemodialysis was performed due to acute renal failure on the same day. On the seventh day, the vital signs became stable. The flow of the pump was lowered and the patient was weaned from ECMO. However, the patient could not be weaned from ventilatory support due to the hemothorax caused by the CPR. Thereafter, weaning from ventilatory support was delayed due to a decline of pulmonary function. The patient organ functions (kidney, lung, liver, heart) were gradually getting worse. The patient expired due to multiple organ failure on day 92. ECMO can be considered in case of cardiac arrest due to reversible causes. (Korean J Anesthesiol 2007; 53: 785~90)