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임상연구 : 한국 성인에서 전산화 단층촬영술을 이용하여 측정한 주기관지 길이
노운석 ( Woon Seok Rho ),신유식 ( Yoo Sik Sinn ),이준석 ( Jun Seog Lee ),박찬홍 ( Chan Hong Park ),박영찬 ( Young Chan Park ),정진용 ( Jin Yong Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: Accurate knowledge of the mainstem bronchial lengths is essential in order to prevent malpositioning of the double lumen endobronchial tubes (DLT). It is believed that the lengths of the left and right mainstem bronchi measured by CT are more accurate than those measured using a fiberoptic bronchoscope. This study evaluated the length of the mainstem bronchus using a CT scan in Korean adults. Methods: One hundred twenty patients who underwent a chest CT scan without any anatomical changes due to a mass or inflammation were examined. Airway imaging with a minimum intensity projection of the oblique coronal section using multidetector CT was obtained and the lengths of the left and right mainstem bronchi were measured. Results: The lengths of the left mainstem bronchus of the males and females were 49.2 ± 4.8 mm and 44.6 ± 3.9 mm respectively, and the right mainstem bronchus of the males and females were 21.0 ± 4.8 mm and 18.0 ± 4.0 mm, respectively. There was no linear correlation between the height of the patients and the length of the left and right mainstem bronchi. Conclusions: These results provide reference data to help determine the precise margin of safety using a double lumen endobronchial tube for thoracic surgery. (Korean J Anesthesiol 2006; 51: 426~9)
안영옥(Yong Wook Ahn),노운석(Woon Seok Rho),김봉일 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2
It is common practice to use epidural catheter for anesthesia or for postoperative anal- gesia and other kinds of pain control. However, Intraspinal infection associated with this practice is rare event. We report a case of spinal subdural abscess occuring in patient who had recently re- ceived epidural catheterization. The cause in this case is not certain, although infection from the epidural catheter is the best possibility. We recommand an aseptic technique in all procedure for epidural or spinal analgesia.
삼차신경통 환자에서 안와상 신경과 활차상 신경에 시행한 박동성 고주파술에 의한 치료경험 -증례보고-
서귀주,신흥동,김종해,송석영,노운석,정진용,Seo, Kwi Chu,Shin, Heung Dong,Kim, Jong Hae,Song, Seok Young,Rho, Woon Seok,Chung, Jin Yong 대한통증학회 2009 The Korean Journal of Pain Vol.22 No.2
Pharmacological management is the first choice for treatment of the trigeminal neuralgia patients; however, if this mode of treatment fails a minimally invasive procedure should be performed. One of the most commonly used procedures is conventional radiofrequency lesioning of the Gasserian ganglion. Despite its popularity and success rate, this technique has disadvantages such as diminished corneal reflex, masseter weakness, numbness and anesthesia dolorosa. As a result, many studies have been conducted in an attempt to find a better method of treating trigeminal neuralgia. We report here a case of a trigeminal neuralgia patient that was treated with pulsed radiofrequency lesioning of the supraorbital and supratrochlear nerve due to pain in the frontal head that was refractory to the pharmacological treatments. Following the procedure, the Visual Analogue Scale score for pain decreased to 1-2/10 and the pain relief persisted for 7 months. These results indicate that pulsed radiofrequency treatment of the peripheral nerve may be useful for trigeminal neuralgia patients that do not respond to pharmacological treatments.
증례보고 : 갑상연골이 정상보다 아래에 위치하며 우측으로 기울어진 환자에서의 어려운 기관내 삽관
박찬홍 ( Chan Hong Park ),김호영 ( Ho Young Kim ),노운석 ( Woon Seok Rho ),김봉일 ( Bong Il Kim ),김정규 ( Jeong Kyu Kim ),정진용 ( Jin Yong Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
We report a case of difficult intubation due to a low located thyroid cartilage and a left deviated glottis abnormality. A 35-year-old woman was scheduled to undergo a laminectomy and discectomy for a L4-5 disc herniation. After injecting intravenous induction agents and muscle relaxant, intubation was attempted with a direct laryngoscope. However, no vocal cords were seen and only the epiglottis was seen albeit only slightly. According to Cormack and Lehane`s grading, the patient was grade III. Although intubation was re-attempted after changing the anesthesiologist and device such as a light wand, the endotracheal tube could not be advanced below the epiglottis because of resistance. When patient was rechecked, her thyroid cartilage was located abnormally low and the thyromental distance was 14.5 cm. In addition, the preoperative chest X-ray revealed her airway to be deviated to the left. Intubation could be successfully performed after additional 100% oxygen mask ventilation. An otolaryngologic examination revealed that the glottic opening was deviated to the left, and ventricle of the larynx, which is normally not seen with a laryngocope was located to the center. It is believed that the reason for resistance of the advancing endotracheal tube was a centrally located ventricle of the larynx. (Korean J Anesthesiol 2006; 51: 742~5)
제왕절개술시 Ultrasonic Doppler 에 의해 탐지된 정맥 공기 색전증의 발생빈도
이상화,노운석,조성경,정진용,이태현 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.6
Venous air embolism(VAE) can occur by the entry of air into open veins, being facilitated if the operative field is above the level of the heart. Among the many diagnostic methods, precordial ultrasonic Doppler is currently the more sensitive. Thus we have attempted to define the incidence of VAE using this device. 103 ASA physical status 1 or 2 parturients undergoing Cesarean section with general anesthesia in 73 parturients and epidural anesthesia in 30 parturients were studied with the ultrasonic Doppler transducer placed parasternally over the 4th right intercostal space. Total incidence of venous emboli was 31%(32/103) during surgery. In some parturients, embolism occurred more than once during operation and leaded to total 45 episodes of venous emboli. The incidence of venous emboli was 26%(19/73 ) during general anesthesia and 43.3%(13/30 ) during epidural anesthesia. No statistical difference existed in the incidence of venous emboli detected related to the type of anesthesia. Among the 45 episodes of venous emboli, 19 episodes(42.2%) were detected during repair of the hysterotomy. As even small air bubbles in the circulation are potentially harmful especially in patent foramen ovale and emboli events may occur at risk cases involving profound hypovolemia, abruptio placenta, or placenta previa, clinically insignificant venous air emboli, although low, is still worrisome. Thus above the cases, the use of additional precordial Doppler monitoring may be considered during cesarean section to detect VAE promptly, efficiently.
척추경막외복합마취시 경막외강으로 일회 주입한 생리식염수가 척추마취의 감각 차단 범위에 미치는 영향
김봉일,노운석,백승희 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3
Background : Combined spinal epidural anesthesia(CSE) is used for obtaining adventages of both spinal and epidural anesthesia. But it might be suspected that epidural volume load affect spinal sensory blockade level during CSE. Methods : Eighty patients undergoing lower abdominal and lower extremity operation were involved in our study. Subarachnoid block with 12mg of tetracaine was established in all patients. Four groups were studied. Group 1(n=20), the control, received only spinal anesthesia. Group 2(n=20), group 3(n=20) and group 4(n=20) received 10, 15 and 20 ml of epidural saline immediately after spinal anesthetic administration. Sensory blockade level was checked by pinprick test at 5, 10, 15, 20, 25, 30, 40, 60 and 90 minutes. Blood pressure, heart rate and incidence of complications such as hypotension, bradycardia, nausea and high block were measured. Results : The sensory blockade level of groups 3 and 4 was higher than group 1(p$lt;0.05). Blood pressure and heart rate were not different compared with each other. The incidence of complications, except that higher block above T4 in group 4 was more than in group 1(p$lt;0.05), were not different when compared with each other. Conclusions : Epidural saline above 15 ml may affect sensory blockade level of spinal anesthesia during CSE. (Korean J Anesthesiol 1997; 33: 485∼490)
예상하지 못한 어려운 기관내 삽관 조작후 발생한 경부 피하기종
이상화,김봉일,노운석,조성경,박태숙,백승희 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.1
Subcutaneous emphysema is one of the rare complication of tracheal intubation and it's mechanism has been known as airleakage to subcutaneous tissue from the perforated site of larynx, trachea and esophagus by the trauma of laryngoscopic blade, stylet and endotracheal tube. We experienced a case of subcutaneous emphysema during unexpected difficult endotracheal intubation. At the initial laparoscopic examination, the patient's laryngeal view was grade IV of Cormack and Lehane's calssification. After several trial of the intubation, cervical subcutaneous emphysema developed by the trauma of laryngoscopic blade, stylet and endotracheal tube, even though failed to confirm the perforated site at postanesthesia one day. (Korean J Anesthesiol 1997; 33: 178∼181)