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Cardiac arrest following reversal of muscle relaxation by pyridostigmine -A case report-
구승우,조준영,이정민,이윤경,박평환 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.3
The anticholinesterase pyridostigmine is usually used as a reversalagent of non-depolarizing muscle relaxants in general anesthesia. Most adverse muscarinic effects of anticholinesterases are controlledby anticholinergics; however, there is still a potential for fatalcardiac complications. We report a case of cardiac arrest associatedwith coronary vasospasm that developed during emergencefrom general anesthesia in a 61-year-old male patient undergoinguvulopalatopharyngoplasty with preoperatively undiagnosed coronaryvasospastic angina. Anticholinesterases should be administeredwith caution for neuromuscular blockade reversal, especially inpatients with coronary vasospastic angina.
소음에 노출된 흰쥐에서 Halothane이 난청과 세포사에 미치는 영향
구승우,이은호,서영주,이현정,강훈희,김종욱,강성식,정종우 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.2
Background: In large clinical series, noise induced hearing loss (NIHL) following middle ear surgery has been demonstrated in 1.2% to 4.5% of patients and it is associated with a lower incidence than expected. The aim of the present work was to analyze the effect of halothane anesthesia on NIHL and hair cell morphological change. Methods: We used 40 BALB/c mice with normal Preyer's reflex to investigate the effect of halothane on the NIHL. Control (n = 20) and halothane group (n = 20, respectively) were exposed to 120 dB SPL (sound pressure level), broad band white noise 3 hours daily for 3 consecutive days. The halothane group was anesthetized with halothane while exposed to noise. Hearing thresholds were determined with the auditory brainstem response (ABR). On day 7 post-noise, mice were sacrificed and the cochlea were collected for the histological study. Results: ABR thresholds in the halothane group were less elevated after noise exposure than in the control group and then gradually recovered. In control group, the damage to the outer hair cell and supporting cell was noticeable, but not in halothane group. The expression of Bcl-2 protein was detected in halothane group, the expression of Bax protein was seen in control group. As a result in TUNEL stain, the result is positive in the control group but negative in the halothane group. Conclusions: The occurrence of NIHL decreased and the tissue damage was suppressed while anesthetized by halothane. And the noise-induced cell death of hair cell was also suppressed during anesthesia. (Korean J Anesthesiol 2006; 50: 198~204
심장수술 시 농축적혈구, 자가수혈기 혈액, 체외 순환기 혈액에서의 유리 혈색소 농도 비교
송장호,구승우,백종화,정용보,이정순,최인철 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5
Background: Intraoperative autotransfusion or residual blood in a cardiopulmonaty bypass (CPB) circuit has been used to reduce the need for an homologous blood transfutsion during cardiac surgery. However, it may contain some free hemoglobin released from damaged cells. The load of blood containing free hemoglobin may cause renal dysfunction. We measured the amount of free hemoglobin in backed blood, cell saver blood and CPB blood to evaluate what is the least hemolytic blood transfused in cardiac surgery. Methods: This study was performed in 20 patients undergoing cardiac surgery. In each patient, the banked blood, intraoperative salvaged blood with a cell saver and CPB residual blood were sampled at the end of the operation. The concentration of free hemoglobin, hemoglobin and platelet counts were measured in these blood samples and percent of hemolysis was calculated (%hemolysis = [free hemoglobin] / .free hemogloben + hemoglobin]) Results: In salvaged blood with a cell saver, CPB residual blood and banked blood, hemoglobin concentrations were 20.1 ± 2.7 g/dl, 8.0 ± 1.1 g/dl, and 22.2 ± 2.7 g/dl, respectively. Free hemoglobin concentrations were 336.6 ± 239.5 mg/dl, 49.2 ± 26.8 mg/dl, and 279.5 ± 167.5 mg/dl respectively. Platelet counts were 26.1 ± 22.2 × 10^3/mm^3, 116.8 ± 56.5 × 10^3/mm^3, and 94.9 ± 43.6 × 10^3/mm^3 respectively. % Hemolysis were 1.6 ± 1.1%, 0.6 ± 0.4%, and 1.2 ± 0.7% respectively. In the comparison between the salvaged blood with a cell saver and CPB residual blood, free hemoglobin concentration, % hemolysis, and platelet counts had positive correlations (r = 0.8, 0.7, and 0.6). Conclusions: In twenty cardiac surgeries, CPB residual blood had a lower free hemoglobin level than the other two blood groups. The platelet counts in CPB residual blood were higher than those in cell saver blood but did not differ from those in banked blood. Therefore, CPB residual blood was the least hemolytic blood among the three blood groups when a transfusion was performed in cardiac surgery. (Korean J Acesthesiol 2002; 43: 588~593)
Cardiovascular collapse due to right heart failure following ethanol sclerotherapy -a case report-
조준영,진지현,박평환,구승우 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.5
Ethanol sclerotherapy for the treatment of low-flow vascular malformations can cause catastrophic cardiopulmonary complications, including pulmonary embolism and pulmonary hypertension, that can result in right heart failure and fatal arrhythmias, leading to death. We here report a case of abrupt cardiovascular collapse that developed immediately following ethanol sclerotherapy in 31-year-old female patient who had a large arteriovenous malformation in her leg. Anesthesiologists should be aware of the fatal cardiopulmonary complications that are associated with ethanol sclerotherapy and consider the use of invasive hemodynamic monitoring, such as pulmonary artery pressure monitoring, when large doses of ethanol are required.
Etomidate 와 Propofol 이 백서 단일심근 세포의 칼슘 전류에 미치는 영향
한성민,최인철,이은주,김원태,이소영,김종욱,구승우 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.1
Background : Cardiovascular instability after induction of intravenous anesthetics may be explained partly by direct negative inotropic effects. We studied the effects of etomidate and propofol on the inward calcium currents (1c,) of rat ventricular myocytes using the whole-cell voltage-clamp technique. Methods : Ic, was elicited by progressively depolarizing cells from -40 to +50 mV. The peak amplitude of Ic, wss measured before, during and after the administration of equirnolar concentrations of etomidate and propofol. Results : Exposure to etomidate and propofol produced a cancentration-dependent inhibition of Ic., 1, 10, 100 and 300 p M of etomidate decreased the peak Ic, (mean±SEM) by 14.5±6.3, 25.9±9.4, 31.9±12.1, 42.5±8.8% and 1, 10, 100 and 300 p M of propofol decreased the peak 4, by 15.7 ±3.4, 21.3-2.5, 59.2±2.0, 69.9±2.8%, respectively. Conclusions : These results suggest that etomidate and propofol have a direct negative inotropic effect via inhibition of inward calcius in rat ventricuiar myocytes. (Korean J Anesthesiol 2000; 39: 111 ~ 118)