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Severe brachial plexus injury after retropubic radical prostatectomy -A case report-
송재격 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.1
A 69-year-old man with prostate cancer underwent surgery for 16 h. Approximately 6 h after surgery, the patient developed severe pain and motor weakness in his right arm. After neurologic examinations that included a nerve conduction study and electromyography, the patient was diagnosed with a brachial plexus injury. The causes of the brachial plexus injury were thought to be abduction of both arms, direct compression of the shoulder brace, and prolonged surgery. Most of the postoperative peripheral nerve injuries due to patient position are preventable, and anesthetists and surgeons should be very careful in positioning the patient accurately.
Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block
송재격,Kee Keun Park,강봉진,전대근 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.1
Background: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. Methods: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. Results: MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. Conclusions: MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.
Ludwig's Angina 환자의 어려운 기도 관리에서 기관지내시경과 비디오 후두경의 병용 경험
송재격,김석곤,배정호,Song, Jaegyok,Kim, Seokkon,Bae, Jeong-Ho 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.4
We experienced dfficult airway management in a patient who had Ludwig angina with morbid obesity, dfficulty with mouth opening and neck extension. We planned to perform awake-nasotracheal intubation with fiberoptic bronchoscopy but the patient's condition was not suitable to do this procedure. Thus, we tried fiberoptic nasotracheal intubation under general anesthesia but we experienced difficult airway management due to epistaxis. We tried to use video laryngoscope instead of fiberpotic bronchoscopy but also failed to guide the tube into trachea due to limited mouth opening. We used video laryngoscope to make a view of vocal cord and used fiberoptic bronchoscope as an intubation guide of endotrachedal tube and successfully intubated the patient.
각성하 굴곡성기관지경 삽관술이 실패한 하악골소체증(Mandibular Microsomia) 환자에서 Airtraq Optical Laryngoscope의 유용성 —증례보고—
송재격,권민아 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.53 No.3
We report here the successful use of the AirtraqⓇ optical laryngoscope (AOL) as a rescue device following failed awake flexible fiberoptic nasotracheal intubation of a patient with severe mandibular microsomia. We attempted awake fiberoptic nasotracheal intubation following topical anesthesia with 4% lidocaine spray three times to induce general anesthesia for distraction osteogenesis of mandibular bone. However, due to a shallow pharyngeal cavity and cranially displaced larynx, we failed to locate the larynx each time and were therefore not able to intubate the patient. Awake orotracheal intubation using the AOL allowed us to easily intubate the patient. Therefore, we recommend that the AOL be used as a rescue airway device for intubation of difficult airways.
송재격,Choi Nayoung,Kang Minji,지성미,김동욱,권민아 대한마취통증의학회 2022 Anesthesia and pain medicine Vol.17 No.1
Background: Postoperative pain occurring after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is difficult to control because of extensive surgical injuries and long incisions. We assessed whether the addition of a four-quadrant transabdominal plane (4Q-TAP) block could help in analgesic control.Methods: Seventy-two patients scheduled to undergo elective CRS with HIPEC and intravenous patient-controlled analgesia (IV PCA) were enrolled. The patients received 4Q-TAP blocks in a 10 ml mixture of 2% lidocaine and 0.75% ropivacaine per site (4Q-TAP group, n = 36) or normal saline (control group, n = 33). Oxycodone in the post-anesthesia care unit (PACU) and pethidine or tramadol in the ward were used as rescue analgesics. The primary outcome was less than 3 times of rescue analgesic administration (%) in the ward for 5 postoperative days. Secondary endpoints included oxycodone requirement in PACU, fentanyl doses of IV PCA, morphine milligram equivalent (MME) of total opioid use, hospital stay, and postoperative complications. Results: During 5 postoperative days, there was no difference in pain scores and total rescue analgesic administration between two groups. However, the use of oxycodone in PACU (P = 0.011), fentanyl requirement in IV PCA (P = 0.029), and MME/kg of total opioid use (median, 2.35 vs. 3.21 mg/kg, P = 0.009) were significantly smaller in the 4Q-TAP group. Hospital stay and incidence of postoperative morbidity were similar in both groups. Conclusions: The 4Q-TAP block enhanced multimodal analgesia and decreased opioid requirements in patients with CRS with HIPEC, but did not change postoperative recovery outcomes.
Laryngeal granulomas in patients after two-jaw surgery - Four cases report -
송재격,조원호,지성미,박정헌,김석곤 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.4
Background: Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it. Case: We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature. Conclusions: There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.
증례보고 : 위암환자의 위전절제술 중 발생한 심장의 무맥박 전기 활동
송재격 ( Jae Gyok Song ),엄우식 ( Woo Sik Eom ),정해정 ( Hae Jeong Jeong ),조대순 ( Dae Soon Cho ),신혜영 ( Hye Young Shin ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Pulseless electrical activity refers to a heterogeneous group of cardiac rhythm disorders, all characterized by pulselessness in the presence of some type of electrical activity other than ventricular tachycardia or ventricular fibrillation. We experienced a case of sudden pulseless electrical activity and cardiac arrest during hetastarch infusion in general anesthesia in an adult who had total gastrectomy. We report this experience with a brief review of literature. (Korean J Anesthesiol 2007; 52: 246~9)
증례보고 : 병적 비만환자에서 쇄골상차단법으로 시행한 상완신경총 차단 후 발생한 호흡곤란
송재격 ( Jae Gyok Song ),김석곤 ( Seok Kon Kim ),전대근 ( Dae Geun Jeon ),권민아 ( Min A Kwon ),유진희 ( Jin Hee Yoo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4
A 57-year-old woman with morbid obesity (BMI: 37.39) was scheduled for ligament reconstruction with tendon interposition of the carpometacarpal joint. A difficult supraclavicular brachial plexus block was performed using a 22-gauge regional block needle with a nerve stimulator and 40 ml of 1% mepivacaine. Approximately 10 minutes after the injection, she complained dyspnea, shortness of breath and right mid-thoracic pain. Her oxygen saturation decreased from 100% to 95%. Diagnostic workup revealed right diaphragmatic elevation caused by phrenic nerve block. General anesthesia was induced because of the unsuccessful brachial plexus block and dyspnea with chest pain. She recovered without any residual complications and was discharged on the third postoperative day. Phrenic nerve block is a common complication in supraclavicular brachial plexus block but it is usually not severe and reassurance is enough to control it. However, pre-operative physical conditions that may lead to decreased respiratory reserves, such as morbid obesity should be considered as a risk factors when conducting supraclavicular brachial plexus block. (Korean J Anesthesiol 2009;57:511∼4)