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고비중 0.5% Bupivacaine의 척추마취 후에 발생된 지속적인 신경손상 -증례 보고-
함태수,고저스틴상욱,진현승 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.2
Persistent neurologic injury is a rare but feared complication of neuroaxial anesthesia.Local anesthetics are believed to be an important cause.A 68-year-old man with an ASA physical status of 2 was scheduled to undergo elective knee arthroplasty.He had no clinical evidence of neurological deficits before the operation. Spinal anesthesia was administered using 10 mg of 0.5% bupivacaine and 20μg of fentanyl without difficulty or complications during the procedure.On the second postoperative day, the patient complained of bilateral weakness in his lower extremities. The neurological examination revealed a sensorimotor impairment consistent with cauda equina syndrome.The neurotoxicity of bupivacaine might have been the cause of this neurological deficit.
김진수,고저스틴상욱,방승욱,김형태,이숙영 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.4
Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/ or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
Recent updates on interscalene brachial plexus block for shoulder surgery
강령아,고저스틴상욱 대한마취통증의학회 2023 Anesthesia and pain medicine Vol.18 No.1
Interscalene brachial plexus block (ISBPB) provides optimal analgesia for shoulder surgery. However, several limitations still exist, including the short duration of analgesia, rebound pain, a high incidence of unilateral diaphragmatic paresis, and potential risk of nerve damage, prompting the search for alternative techniques. Many alternatives to ISBPB have been studied to alleviate these concerns, and clinicians should choose an appropriate option based on the patient’s condition. In this mini-review, we aimed to present recent updates on ISBPB while discussing our clinical experiences in shoulder surgery.
오른쪽 내경 정맥을 통한 중심 정맥관 삽입 후 동측 쇄골하 정맥으로의 위치 이상 -증례 보고-
양수현,고저스틴상욱,김갑수,곽미숙 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.3
Central venous catheters can provide important hemodynamic information in patients with cardiopulmonary disease and access for medicine, fluid, and blood administration during surgery. The placement of central venous catheters is associated with a complication rate of 0.4% to 20%, including pneumothorax, arterial puncture, infection and cardiac tamponade. In addition, malposition of central venous catheter is another complication of central venous catheterization. We report a case of malpositioning of central venous catheter which is located in the right subclavian vein via internal jugular vein in a liver transplant recipient. The malpositioning was confirmed by portable X-ray after several field attempts to advance Swan-Ganz catheter and achieve normal sequences of pressure waves.
오아란,고저스틴상욱,김갑수 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.1
Background: There have been many reports about decreased analgesic requirements in liver transplant recipients compared with patients undergoing other abdominal surgery. Case: Herein we describe a case in which a 42-year-old man underwent living donor liver transplantation from his monozygotic twin. Because innate pain thresholds may be similar in monozygotic twins, we could effectively investigate postoperative pain in the donor and the recipient. Concordant with previous reports, the recipient used less analgesic than the donor in the present study. Conclusions: Physicians caring for patients who have received liver transplantation should consider their comparatively low requirement for analgesic, to prevent delayed recovery due to excessive use of analgesic.
한상빈,최정희,고저스틴상욱,곽미숙,이석구,김갑수 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.4
Background: Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation. Methods: Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points. Results: Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6oC vs. FMS, 35.4oC, P = 0.122). Conclusions: A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.
우측 대동맥 활을 동반한 팔로씨 사징 환아에서 경식도 심초음파 소식자 삽입 후 발생한 환기 장애 -증례보고
윤세정 ( Se Jeong Yoon ),고저스틴상욱 ( Justin SangWook Ko ),김정수 ( Chung Su Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Right aortic arch, a congenital malformation of the great vessels, can cause compression of trachea and/or esophagus. We experienced a case of ventilatory compromise in an infant with tetralogy of Fallot and right aortic arch immediately after insertion of transesophageal echocardiography probe during cardiac surgery. Although intraoperative transesophageal echocardiography can be safely performed in infants with congenital heart disease, it should be done with caution in patient with similar vascular malformation. (Korean J Anesthesiol 2009; 57: 104~7)