전격성 간부전 환자의 간이식 마취관리 : 뇌압과 경정맥 산소포화도 감시의 관점에서

석은하,조인숙,황규삼,최규택 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.2

임상연구 : 제왕절개술을 위한 Enflurane 마취와 Sevoflurane 마취의 비교

석은하 ( Eun Ha Suk ),정지연 ( Jee Yeon Jeong ),이윤경 ( Yoon Kyung Lee ),김영국 ( Young Kug Kim ),조성강 ( Sung Kang Cho ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.6

전신마취 유도 직후 발생한 심방조동과 심방세동으로의 전환 -증례 보고-

송진철,석은하,조재형,주완,이철승,임용석 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.1

The most frequent perioperative cardiovascular event is cardiac dysrhythmia, defined as an abnormality of cardiac rate, rhythm or conduction. Although the occurrence of arrhythmia during the perioperative period is not uncommon, a case of newly developed perioperative atrial flutter which spontaneously converts to atrial fibrillation is rare. We report a case of atrial flutter that developed immediately after induction of general anesthesia, in a 70-year-old male patient who previously had a normal sinus rhythm. Atrial flutter changed spontaneously to atrial fibrillation after discharge to the recovery room. Dysrhythmia was unresponsive to drug therapy, and the atrial fibrillation disappeared after electric cardioversion.

Enflurane 마취중 젊은 환자와 노인환자에서 호흡기계 역학의 비교

정성문,박평환,석은하,황규삼,심지연,강지영,이병옥 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.4

Background : The aim of this study was to compare the respiratory mechanics between young and elderly during enflurane anesthesia using flow-interruption technique. Methods : Fourteen patients were divided into 2 groups; for young aged group (Group Y)(24.9±4.9 years) and old aged group (Group O)(73.4±5.6 years). After anesthetic induction, endotracheal intubation was performed with Univent tube, and then tracheal pressure was measured at the distal end of the tube. 1.5 vol% of enflurane and 0.15 mg/kg of vecuronium were administered to maintain anesthesia. IMV (intermittent mandatory ventilation) was applied with Siemens Servo 900C ventilator and anesthetic gases were supplied via low pressure inlet of the ventilator. Tidal volume (10 ml/kg) was fixed during measurements for each patient. After stabilization of vital signs, respiratory parameters were measured before surgery. End-inspiratory occlusion was applied at least 3 seconds. Pressure, flow and volume were monitored and recorded with Bicore CP100 pmonary monitor. The data were transfered to a PC and analyzed by a processing software. Total respiratory (Rrs), airway (Raw) and tissue (Rve) resistances, and dynamic (Cdyn) and static (Csta) compliances were calculated. Mann-Whitney U test was used for statistical analysis. Results : There were no statistically significant differences for the Cdyn and Csta values between the two groups. But the values of Rrs, Raw and Rve were higher in the Group O than the Group Y. Conclusion : During enflurane anesthesia, the values of Rrs, Raw and Rve were higher in the Group O than the Group Y. To elucidate the exact causes of the above results, further studies are needed. (Korean J Anesthesiol 1998; 35: 669∼673)

다절편 전산화단층촬영에서 복합성 관상동맥 경화판 분석: 고식적 관상동맥 혈관조영술과의 비교

김동훈,방덕원,석은하,조윤행 대한영상의학회 2011 대한영상의학회지 Vol.64 No.4

Purpose: To delineate complex plaque morphology in patients with stable angina using coronary computed tomographic angiography (CTA). Materials and Methods: 36 patients with complex plaques proven by conventional coronary angiography (CAG), who had taken CTA for evaluation of typical angina, were enrolled in this study. Intravascular ultrasonography (IVUS) was performed in 14 patients (16 lesions). We compared CTA with CAG for plaque features and analyzed vascular cutoff, intraluminal filling defect in a patent vessel, irregularity of plaque, and ulceration. Also, the density of plaque was evaluated on CTA. Results: CAG and CTA showed complex morphology in 44 cases (100%) and 34 cases, (77%), respectively, with features including abrupt vessel cutoff (27 vs. 16%, κ= 0.57), intraluminal filling defect (32 vs. 30%, κ= 0.77), irregularity (75 vs. 52%, κ= 0.52), and ulceration (16 vs. 11%, κ= 0.60). CTA indicated that the complex lesions were hypodense (mean = 66 ± 21 Houndsfield Units). Conclusion: CTA is a very accurate and useful non-invasive imaging modality for evaluating complex plaque in patients with typical angina. 목적: 관상동맥 전산화단층촬영 혈관조영술(coronary CT angiography, 이하 관상동맥CTA)을 이용하여 안정형 협심증에서 보이는 복합적 경화판의 특성을 분석하고자 하였다. 대상과 방법: 안정형 협심증의 전형적인 흉통으로 관상동맥CTA를 촬영한 환자 중 고식적인 혈관조영술(conventional coronary angiography, 이하 CAG)로 경화반이 확진된 36명을 대상으로 하였다. 혈관내초음파(intravascular ultrasonography, 이하 IVUS)는 14명 (16병변)에서 시행되었다. 경화판 형상에 대해 CTA 결과를 CAG와 비교하였으며 혈관 단절, 혈관내 결손, 혈전의 비정형성, 혈전궤양을 분석하였다. 또한, CTA에서 혈전의 음영을 조사하였다. 결과: CAG 와 CTA상 각각 44예, 34예의 복합적인 경화판(100%, 77%)이 진단되었으며 혈관 단절(27 vs. 16%, κ= 0.57), 혈관 내 결손(32 vs. 30%, κ= 0.77), 경계의 비정형성(75 vs. 52%, κ= 0.52), 궤양(16 vs. 11%, κ= 0.60)이 확인되었다. 관상동맥CTA에서 경화판의 평균 음영은 66 ± 21 HU 였다. 결론: 관상동맥CTA는 전형적인 협심증 환자에서 복합적인 경화판을 검사하는 정확하고 유용한 비침습적인 영상법이다.

Aneurysm of the Common Iliac Vein Mimicking a Pelvic Mass

윤은주,김동훈,석은하 대한영상의학회 2013 대한영상의학회지 Vol.69 No.1

Venous aneurysm, especially of primary origin, is rare. The authors report a case of a 63-year-old female who was admitted for back pain and an aneurysm of the common iliac which was detected incidentally. CT, magnetic resonance (MR), Doppler ultrasonography, and conventional venography showed an aneurysm of the left common iliac vein measuring 4.5 × 3 × 4 cm. Because there were no complications of the aneurysm, no further treatment was administered. Herein, we describe findings of a venous aneurysm of the common iliac vein mimicking a pelvic mass on CT and MR scans and with a review of the literature.

갑상샘절제술 후에 발생한 통증성 호너증후군 -증례 보고-

이명수,서영중,석은하,박천희 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.3

Horner syndrome is characterized by miosis, partial blepharoptosis and anhidrosis on the affected side of the face. This syndrome develops when the oculosympathetic nerve pathways to the eye and face are interrupted by various causes such as tumor in the brain, intrathoracic region or neck, surgery, drugs, trauma, carotid artery dissection, and others. It is referred to as painful Horner syndrome when Horner syndrome is accompanied by hemifacial pain. Pain is probably related to trigeminal nerve injury. Horner syndrome is a rare complication of thyroidectomy. Here, we report the case of a patient who experienced ipsilateral painful Horner syndrome after total thyroidectomy and unilateral neck dissection for thyroid cancer.

고양이의 뇌허혈-재관류 모델에서 산화질소 합성효소의 억제가 뇌에너지 대사에 미치는 영향 : 31P 와 1H 자기공명분광법을 이용한 연구 Investigated by 31P and 1H Magnetic Resonance Spectroscopy

이정희,박평환,석은하,임근호,임태환 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.2

Background : The effects of the inhibitor of nitric oxide synthase (NOS) in cerebral ischemia have been debated. Recently, it has been suggested that it depends on the amount of the inhibitor used. Therefore, this study was carried out to evaluate the effects of the NOS in the acute ischemia-reperfusion of the cat model using variable amounts of the inhibitor. Methods : Nineteen cats were divided into 3 groups: group 1 (n = 6), 10 mg/kg of N-nitro-L-arginine methyl ester (I.-NAME); group 2 (n = 7), 0.5 mg/kg; group 3 (n = 6), control group. Incomplete global cerebral ischemia was induced by ligation of both carotid arteries with arterial hypotension (―40 mmHg) for 30 minutes followed by 3 hours of reperfusion. The NOS inhibitor (L-NAME), was injected intra peritoneally 5 minutes before reperfusion. $quot;P and 'H MR spectroscopy were performed. A series of spectra was acquired in the time intervals before ligation, during ischemia, and after reperfusion Results: Phosphocreatine/inorganic phosphate (PCr/Pi) atios for group 1 were significantly lower than for groups 2 and 3 (P $lt; 0.05), and there was no significant difference between groups 2 and 3. Lactate/N-acetyl aspartate (Lac/NAA) and lactate/creatine (Lac/Cr) ratios at 180 minutes after reperfusion were higher for group l than for groups 2 and 3 (P $lt; 0.05). There were no significant differences in pH and lactate/choline (Lac/Cho) ratios among the 3 groups. Conclusions : It is demonstrated that the effect of the NOS inhibitor is dosage dependent. A high dose (10 mg/kg) of L-NAME seems to have an adverse effect on recovery of the ischemia, but a low dose (0.5 mg/kg) seenm to have no effect. (Korean J Anesthesiol 2000; 38: 340~347)

Clonidine 경구 전투약이 기관내 삽관 후 호흡기계 역학의 변화에 미치는 효과

전희정,박평환,석은하,황규삼,강지영,천성관 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4

Background : The aim of this study was to evaluate the influence of oral clonidine premedication on respiratory mechanics by tracheal intubation in smokers. Methods : Thirty male smoker patients were randomly divided into 3 groups. For group 1 (n = 10), l μg/kg of clonidine was premedicated. For group 2 (n = 10), 2 μg/kg of clonidine was premedicated. Group 3 (n = 10, control group) was the no premedication group. After anesthetic induction, CMV was applied with a Siemens Servo 900C ventilator, and anesthetic gases were supplied via the low pressure inlet of the ventilator. Tidal volume (10 ml/kg) was fixed during measurements for each patient. End-inspiratory occlusion was applied for at least 3 seconds and tracheal pressure was measured at the distal end of the endotracheal tube. Pressure, flow and volume were monitored and recorded with a Bicore CP-100 pulmonary monitor. Data were measured after 2 (100% O2) and 5 (1.5 vol% enflurane with 50% N2O) minutes of tracheal intubation. Data were transferr to PC and analyzed by processing software (ANADAT). Total respiratory (Rrs), airway (Raw) and tissue (Rve) resistances, along with static (Cstat), dynamic (Cdyn) compliances were calculated. Results : There were no significant differences for Rrs, Raw, Rve, Cstat and Cdyn in the three groups. Conclusions : Oral clonidine premedication in dosages up to 2 μg/kg do not affect the changes of respiratory mechanics caused by tracheal intubation in smokers. (Korean J Anesthesiol 1999; 37: 545∼550)

Usefulness of Ultrasound in the Evaluation of Morphologic Change of a Cirrhotic Liver During Respiration

변주남,김동훈,석은하 대한초음파의학회 2010 ULTRASONOGRAPHY Vol.29 No.4

Purpose: This study was designed to determine whether transabdominal ultrasound can detect different hepatic stiffness between patients with cirrhosis and control subjects. Materials and Methods: Sevent-three patients (Child-Pugh class A stage) with liver cirrhosis and 57 control subjects were included in this study. All patients were subdivided arbitrarily into two groups: early cirrhosis (n = 53) and overt cirrhosis (n =20). Two sagittal images of the left lobe of the liver were obtained in the left hepatic vein level during the resting state and at full inspiration while pushing their belly out, by abdominal US (i.e., resting and stress image). The length between the inferior hepatic angle and the midpoint of the liver dome was measured in all images for the evaluation of liver distortion. The elongation was calculated by a formula: (L2-L1/L1) ×100(%); where L1 and L2 are the length of the liver for both the resting and stress image. The calculated elongated length (L2-L1, EL) and elongation rate were compared between cirrhotic patients and control subjects. Results: For the control subjects, early cirrhosis, and overt cirrhosis groups, the mean ELs (elongation rate) were 2.34±0.98 cm (30.2±13.2%), 1.18±0.73 cm (14.9±9.5%) and 0.53±0.54 cm (6.3±6.6%), respectively. This difference among the three groups was statistically significant (p < 0.05). A possible best cut-off value of liver elongation rate is 17% for the prediction of cirrhosis (sensitivity: 90%, specificity:75.3%). Conclusion: The liver of patients with liver cirrhosis is stiffer than that of control subjects. Calculation of the elongation rate in the left lobe of the liver during a respiratory maneuver may be used as an ancillary method of US for the evaluation of liver cirrhosis.