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정신지체 환자의 단독 소장천공으로 인한 응급개복수술 중 발생한 심정지와 성공적인 소생술
김난설,정경택,전혜림 순천향대학교 순천향의학연구소 2016 Journal of Soonchunhyang Medical Science Vol.22 No.2
We present successful resuscitation in a mentally disabled young male who has isolated jejunal perforation without trauma history. Abdominal computed tomography scan showed large amount of free intraperitoneal air. Cardiac arrest occurred after anesthetic induction. Following resuscitation, emergent exploratory laparotomy revealed only a 3-cm perforation of the jejunum, 40 cm from the ligament of Treitz. During operation, repeated cardiac arrest occurred. Fortunately, the operation was successfully completed and patient discharged 15th day after operation without complications.
김난설 순천향대학교 순천향의학연구소 2021 Journal of Soonchunhyang Medical Science Vol.27 No.2
Catastrophic carbon dioxide (CO2) embolism is a rare, but potentially life-threatening, the complication of laparoscopic gynecologic surgery. We report the case of a healthy 53-year-old woman who developed CO2 embolism and cardiac arrest during laparoscopic surgery. She had a history of two cesarean sections and had extensive peritoneal adhesions. After placement of the trocar and insufflation of CO2, end-tidal CO2 dropped from 35 to 15 mm Hg, and the patient had a cardiovascular collapse. In this patient, CO2 embolism was diagnosed on the basis of a sudden decrease in end-tidal CO2, hypotension, and hypoxemia. The patient was managed quickly and aggressively. The patient recovered completely following the treatment for CO2 embolism, with no cardiopulmonary or neurological sequelae. There is an increased risk of catastrophic CO2 embolism during laparoscopic gynecologic surgery in patients with previous abdominal surgery. Therefore, the surgeon and anesthesiologist should remain vigilant to promote early detection of CO2 embolism.
김난설,강규식,유시현,정진헌,정지원,서용한,정호순,전혜림,공형윤,이현영,문성택 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.3
Background: We planned to compare the effect of intravenous oxycodone and fentanyl on post-operative pain after laparoscopic hysterectomy. Methods: We examined 60 patients were randomized to postoperative pain treatment with either oxycodone (n = 30, Group O) or fentanyl (n = 30, Group F). The patients received 10 mg oxycodone/100 μg fentanyl with ketorolac 30 mg before the end of anesthesia and then continued with patient-controlled analgesia for 48 h postoperatively. Results: The accumulated oxycodone consumption was less than fentanyl during 8, 24 and 48 h postoperatively. Numeric rating score of Group O showed significantly lower than that of Group F during 30 min, 2, 4, 8 and 24 h postoperatively. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea was higher in the Group O during the 24 and 48 h postoperative period. Conclusions: Oxycodone IV-PCA was more advantageous than fentanyl IV-PCA for laparoscopic hysterectomy in view of accumulated oxycodone consumption, pain control and cost beneficial effect. However, patient satisfaction was not good in the group O compared to group F.
경요도방광종양절제술 중 발생한 경요도절제후증후군: 증례보고
김난설 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.2
Transurethral resection (TUR) of bladder tumor may be complicated with bladder perforation associated with intraperitoneal and retroperitoneal extravasation of irrigation fluid, which may rarely evolve in specific hydroelectrolyte imbalance characterized with hyponatremia, intravascular volume deficit, and renal impairment. Signs and symptoms of cardiovascular dysfunction secondary to hyponatremia, prolonged resection, and intravascular volume deficit may also occur, such as severe hypotension, bradycardia, and cardiac arrest. It is most important to prevent TUR syndrome by using an accurate technique. If bladder perforation occurs, early detection is important for the appropriate treatment.
정규 수술을 받는 환자에서 아스피린 복용이 platelet function analyzer-100 collagen-epinephrine closure time에 미치는 영향
김난설,유시현,정해운 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4
Background: There is a growing need for precise blood coagulation tests in preparation for an operation, as a growing number of patients take aspirin during the run-up to their operation. Against this backdrop, we planned to find what effect aspirin has,if taken regularly prior to an operation, on primary hemostasis. We also attempted to determine the possibility of regional anesthesia in cases which the Platelet function analyzer-100 collagen-epinephrine closure time (PFA-100 C/EPI CT) is prolonged. Methods: We examined three groups the impact of aspirin on the result of the PFA-100 C/EPI CT: Group A (n = 60) consisted of control; Group B (n = 54) who taking aspirin every day until surgery;and Group C (n = 60) was composed of patients who stopped taking aspirin for 7 days before surgery. PFA-100 collagen adenosine-5-diphosphage closure time were only performed on those with abnormal PFA-100 C/EPI CT. Results: PFA-100 C/EPI CT of Group B was significantly longer than Group C and Group A. There was no distinction between Group A and Group C in terms of the PFA-100 C/EPI CT. Conclusions: PFA-100 C/EPI CT has better sensitivity and specificity than a bleeding test; moreover, it is an easy-to-use and point-of-care test. We concluded that regional anesthesia can be performed for those who taking aspirin until their surgery despite their prolonged collagen-epinephrine closure time except prolonged collagen adenosine-5-diphosphate closure time.
김난설,Sung Hyun Kang,박선영 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.4
Abdominal aortic aneurysm is included in the differential diagnosis of lower back pain. Although rare, this important disease can cause potentially lethal complications. In this case, expanding abdominal aortic aneurysm coexisted with intervertebral disc extrusion. The diagnosis of abdominal aortic aneurysm was delayed, putting the patient at risk of aneurysmal rupture. In the management of patients with degenerative spinal diseases, we should not overlook the possibility of comorbidities such as an abdominal aortic aneurysm. We also suggest the importance of interpreting images more carefully, especially for elderly male patients.
인슐린 비의존형 당뇨병성 케톤산증 환자의 마취경험 : 증례보고 A case report
강규식,김난설,김지은 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
The most serious acute complication of DM is diabetic ketoacidosis (DKA). Medical and surgical illnesses account for 50% of episodes of DKA. Infection, myocardial infarction, cerebral vascular accidents, gastrointestinal bleeding, trauma, pancreatitis, and burns are the most common medical causes. The mortality rate from DKA has been reduced to less than 5%. Patients with insulin-dependent diabetes mellitus (IDDM) are more prone to DKA than those with noninsulin-dependent diabetes mellitus (NIDDM). Older diabetics account for approximately 75% of patients who present with DKA. The signs and symptoms of DKA result from hyperglycemia or ketoacidosis. We report a case of anesthetic management of a patient with noninsuline-dependent diabetic ketoacidosis after trauma.
Nuss 방법에 의한 오목가슴 수술 시 금속막대 삽입 후 발생한 긴장성 기흉 -증례보고-
강규식,김난설,안기량,김천숙,유시현,정진헌 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.4
Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view and improvement of the pulmonary function, but the complications such as heart injury, bar displacement, hemothorax, pneumothorax and tension pneumothorax sometimes occur. We experienced a 12 year-old female, who showed profound hypotension with a bradycardia and severe reduction in oxygen saturation followed by the tension pneumothorax after the operation by the Nuss method. The patient was treated with the immediate thoracostomy and recovered without any other problem. In anesthetic management of the pectus excavatum repair by the Nuss method, we should always pay attention to the possible occurrence of tension pneumothorax.