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실험연구 : 흰쥐의 장간막 동맥에서 성별에 따른 Myoendothelial Gap Junction의 분포와 혈관 긴장도에 대한 영향
한선숙 ( Sun Sook Han ),박재현 ( Jae Hyon Bahk ),허진 ( Jin Huh ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: Besides prostacyclin and nitric oxide, the endothelium-derived hyperpolarizing factor (EDHF), which is another distinct endothelium-dependent vasodilator, is involved in relaxing the vascular smooth muscle cells. The myoendothelial gap junction (MEGJ) and female sex hormone play important roles in the EDHF-mediated responses. Therefore, this study was designed to determine the influence of gender on the gap junctional distribution and endothelium-dependent vasodilation in the rat mesenteric arteries. Methods: Male and female Sprague-Dawley rat were euthanized and the tertiary branch of the mesenteric artery was harvested. Immunohistochemistry and confocal microscopic examination of the arterial wall were performed after treating them with specific antibodies to delineate the distribution of connexin 43, a gap junctional protein. Segments of the mesenteric artery, 5 mm in length, were connected to two tungsten wires under isometric tension. The arterial segments were suspended in a modified Krebs solution (37℃) aerated with 95% O2 and 5% CO2 in a vertical water-jacketed temperature-controlled tissue bath. The standard dose-response curve for acetylcholine (10-9-10-5 M) was drawn in the presence of the NO synthase inhibitor, Nω-nitro-L-arginine methyl ester (L-NAME; 10-4 M) plus indomethacin (10-5 M) and/or gap junctional inhibitor, carbenoxolone (10-4 M). Results: In the female rat mesenteric artery, the gap junctional plagues were more prevalent particularly along the endothelial layer. The inhibition of the relaxation response to acetylcholine was depressed in the presence of L-NAME plus indomethacin and augmented in the presence of carbenoxolone when compared with the male rat mesenteric arteries (P < 0.05). Conclusions: Gender differences in the rat mensenteric arteries have an effect on the expression of connexin 43 and the release of EDHF through MEGJ may play a key role in controlling the female arterial tone. (Korean J Anesthesiol 2006; 51: 720~6)
증례보고 : 총대동맥활치환술 이후 혈액투석을 받은 환자에서 발생한 헤파린 기인성 혈소판 감소증 -증례보고-
정희진 ( Hee Jin Jeong ),김재광 ( Jae Kwang Kim ),최주연 ( Ju Yeon Choi ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박경운 ( Kyoung Un Park ),박재현 ( Jae Hyon Bahk ),안혁 ( Hyuk Ahn ),김종성 ( Chong Sung Kim ),김용락 ( 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Heparin-induced thrombocytopenia (HIT) is an immunologically mediated complication of heparin therapy resulting in the consumption of platelets and a catastrophic thromboembolism. Both the clinical and laboratory features are important for a diagnosis of HIT. There have been 3 case reports of suspected HIT in Korea. However none have satisfied the laboratory features. We experienced a case of HIT, which satisfied both clinical and laboratory features, in a patient who received heparin during continuous veno-venous hemodiafiltration (CVVHD) used to treat acute renal failure that developed after a total aortic arch replacement with a cardiopulmonary bypass. The decreased platelet count and obstruction of extracorporeal filter of CVVHD by the blood clot was observed while receiving unfractionated heparin. The serum from the patient contained the anti heparin-platelet factor 4 antibody, and the condition was thus diagnosed as HIT. Argatroban, which is a direct thrombin inhibitor, was used to treat the thrombosis. (Korean J Anesthesiol 2006; 50: 600~4)
증례보고 : 대동맥판막과 상행대동맥 치환술 중 치명적 뇌경색이 발생한 환자에서 대뇌산소포화도와 경정맥 산소포화도의 변화
최은수 ( Eun Su Choi ),김재헌 ( Jae Hun Kim ),길남수 ( Nam Su Gil ),이종환 ( Jong Hwan Lee ),전윤석 ( Yun Seok Jeon ),김경환 ( Kyung Hwan Kim ),박재현 ( Jae Hyon Bahk ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Despite reductions in surgical mortality, neurologic sequelae remain a devastating complication after cardiac surgery with cardiopulmonary bypass. Neurologic complications may be induced by a massive air embolism during cardiopulmonary bypass, even with extensive monitoring. This report describes a patient who had a fatal cerebral infarct during aortic valve and ascending aorta replacement surgery. We monitored jugular venous O2 saturation (SjvO2) and cerebral oximetry using near-infrared spectroscopy in the perioperative period. The operation and anesthesia were uneventful until the deep hypothermic total arrest for the replacement of the ascending aorta. However, restarting the cardiopulmonary bypass after deep hypothermic total arrest produced a brief (less than 10 seconds) but large amount of air in the root cannula. At this time, although cerebral oximetry did not show any changes, the SjvO2 decreased to 21% for about 3 minutes and then normalized. At 8 hours after surgery, the patient showed seizures and severe edema in both cerebral hemispheres on the MRI. The patient died 21 days after surgery. (Korean J Anesthesiol 2009;56:102~5)
임상연구 : 한국 성인 남자에서 방정중법(Paramedian Approach) 시 적절한 삽입각도는 얼마인가?
김진태 ( Jin Tae Kim ),김수환 ( Soo Hwan Kim ),배만석 ( Man Seok Bae ),박승재 ( Seung Jae Park ),김정훈 ( Jeong Hoon Kim ),손호정 ( Ho Jeong Son ),박재현 ( Jae Hyon Bahk ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: The object of this study is to offer the optimal angle of needle insertion during L3-L4 paramedian approach using simple X-ray. Methods: Twenty-five male patients were enrolled for this study. After placing a radio-opaque material (RO) on the point 1cm lateral and 1cm caudad to inferior edge of L3 spinous process in the sitting-flexion position, simple AP X-ray films in erect position and lateral films in sitting-flexion position were taken. The distance from RO (I) to the midline of vertebral column was measured on the AP film. On the lateral film, the optimal target point (T) was determined. When the real RO (I) appeared on lateral film, the point was named I`. The line perpendicular to the line tangential to skin on I` was drawn to the vertebral body. When another line perpendicular to that line was drawn from the target point (T), the two lines meet perpendicularly at the point C. Two triangles can be formed three-dimensionally with T, I`, C and T, I, C. Medial insertion angle (α, angle I-C-I`) and cephalad insertion angle (β, angle T-I-C) were calculated. Results: The mean angle of α was 10.7 ± 2.3˚ and β was 13.9 ± 5.0˚. The insertion based on the calculated angles was successfully achieved at the first trial in 24 patients and at the second in 1 patient. Conclusions: Spinal anesthesia with L3-L4 paramedian approach can be successfully performed using calculated angles measured by simple X-rays. (Korean J Anesthesiol 2006; 50: 413~6)
증례보고 : 체외순환 없는 관상동맥 우회술 중 발생한 승모판막 전방이동에 의한 좌심실 유출로 폐쇄로 인한 저혈압
설태경 ( Tai Kyung Seol ),이종환 ( Jong Hwan Lee ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ),김기봉 ( Ki Bong Kim ),김종성 ( Chong Sung Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Systolic anterior motion of the mitral valve (SAM) is well known in the concentric left ventricular hypertrophy or post mitral valvuloplasty. However, SAM has not been reported in Off-pump coronary artery bypass surgery (OPCAB). Preoperatively, SAM in combination with a left ventricular outflow tract obstruction leads to severe cardiovascular destabilization. Moreover, a diagnosis of SAM is very important because the administration of conventional therapy to hypotension can aggravate SAM. We report a patient with un-identified left ventricular wall hypertrophy or mitral valve regurgitation, who was diagnosed with SAM by TEE during OPCAB. This report describes the diagnostic and therapeutic strategies for the perioperative management of SAM. (Korean J Anesthesiol 2007; 53: 242~5)
임상연구 : 머리의 자세가 우측 쇄골하 중심정맥도관의 위치에 미치는 영향
류호걸 ( Ho Geol Ryu ),이상진 ( Sang Jin Lee ),권정은 ( Jung Eun Kwon ),최주연 ( Ju Youn Choi ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: Confirmation of central venous catheter position with chest X-ray is recommended, but frequently omitted in clinical practice. It was suggested that the head posture during right subclavian catheterization affects the incidence of catheter malposition in infants. We evaluated the influence of the head posture on catheter position during right subclavian catheterization in adults. Methods: Two-hundred and seventy four patients scheduled for thoracic or neuro-surgery requiring central venous catheterization were enrolled. Patients were divided into 3 groups depending on the head posture during catheter insertion: the neutral group (n = 109), the turn away group (n = 72), and the turn toward group (n = 93). The catheter position was confirmed with postoperative chest X-ray. Results: Central venous catheterization was failed in 5 patients. There were no differences in the incidence of catheter malposition and the complications among the 3 groups. Conclusions: The head posture during right subclavian catheterization did not affect catheter malposition and immediate complication rates. (Korean J Anesthesiol 2007; 52: 627~9)
임상연구 : 경막외 마취를 이용한 각성하 관상동맥우회술
김진태 ( Jin Tae Kim ),이종환 ( Jong Hwan Lee ),윤승주 ( Seung Zhoo Yoon ),최주연 ( Ju Yeon Choi ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ),김기봉 ( Ki Bong Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: Recently, awake coronary artery bypass graft (ACAB) with spontaneous ventilation has been performed under thoracic epidural anesthesia (TEA) without general anesthesia. We report our first experiences of 12 cases of ACAB with full median sternotomy under TEA. Methods: Between March and September 2005, 12 patients underwent ACAB under TEA. The thoracic epidural catheter was placed at the level of T1 and/or T8 vertebral body according to surgical plan. Seven to fifteen milliliter of 2% lidocaine and sufentanil 1.66μg/ml was administered through the epidural catheter. Results: There were 11 male and 1 female patients, aged 67 ± 7 years. In 10 (83.3%) patients, pneumothorax was observed during surgical intervention. During the operation, 5 patients needed to be received general anesthesia because of respiratory distress caused by pneumothorax (n = 3), bowel protrusion (n = 1) or bleeding (n = 1). Mean length of stay in intensive care unit and hospital stay were 1.5 ± 1.2 days and 6.3 ± 1.7 days, respectively. Conclusions: Our initial experience confirms the feasibility of performing ACAB under TEA. However, high rate of conversion to general anesthesia and development of pneumotorax should be considered. Therefore, the actual and potential risks of ACAB under TEA should not be underestimated. (Korean J Anesthesiol 2006; 51: 421~5)